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Differential Loss to Follow-up by Insurance Status in the Health and Retirement Study: Implications for National Estimates on Health Insurance Coverage

Differential Loss to Follow-up by Insurance Status in the Health and Retirement Study:... We read with interest the article by Baker and Sudano1 titled “Health Insurance Coverage During the Years Preceding Medicare Eligibility.” The combination of lacking health insurance and the benefits from affordability of medical care that come with health insurance are greatest in the years preceding Medicare eligibility. Baker and Sudano1 estimated the percentage of uninsured individuals as the Health and Retirement Study (HRS) cohort aged over time. They found that the percentage uninsured respondents aged 51 to 57 years in the baseline wave dropped from 14.3% in 1992 to 8.2% in 2000. We used the Current Population Survey’s (CPS) Annual Demographic Survey, a nationally representative cross-sectional survey of 50 000 households conducted by the Bureau of the Census, to estimate the percentage uninsured for the same age cohorts and found it to be stable between 1992 and 2000 (Table). Table. View LargeDownload Percentage Uninsured From 1992 to 2000 Based on the HRS, the estimates by Baker and Sudano1 suggest that there is a sharp decline in the probability of being uninsured as the cohort aged 51 to 57 years approaches age 65 years. However, the stable nationally representative estimates from the CPS suggest that their claim is most likely an artifact of the differential dropout by insurance status in the HRS. While the overall rate of loss to follow-up is 7.4% in 1994 (as reported by Sudano and Baker1), we estimated this rate to be 6.7% among the insured and 13.8% among the uninsured. This dropout pattern continues in all survey waves and is not accounted for in HRS survey weights. Hence, one must account for this differential dropout in the HRS when using this survey to generate national estimates of health insurance coverage in this age cohort. Correspondence: Dr Polsky, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Blockley Hall, Room 1212, 423 Guardian Dr, Philadelphia, PA 19104 (polsky@mail.med.upenn.edu). References 1. Baker DWSudano JJ Health insurance coverage during the years preceding Medicare eligibility. Arch Intern Med 2005;165770- 776PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Differential Loss to Follow-up by Insurance Status in the Health and Retirement Study: Implications for National Estimates on Health Insurance Coverage

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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.165.21.2537-b
Publisher site
See Article on Publisher Site

Abstract

We read with interest the article by Baker and Sudano1 titled “Health Insurance Coverage During the Years Preceding Medicare Eligibility.” The combination of lacking health insurance and the benefits from affordability of medical care that come with health insurance are greatest in the years preceding Medicare eligibility. Baker and Sudano1 estimated the percentage of uninsured individuals as the Health and Retirement Study (HRS) cohort aged over time. They found that the percentage uninsured respondents aged 51 to 57 years in the baseline wave dropped from 14.3% in 1992 to 8.2% in 2000. We used the Current Population Survey’s (CPS) Annual Demographic Survey, a nationally representative cross-sectional survey of 50 000 households conducted by the Bureau of the Census, to estimate the percentage uninsured for the same age cohorts and found it to be stable between 1992 and 2000 (Table). Table. View LargeDownload Percentage Uninsured From 1992 to 2000 Based on the HRS, the estimates by Baker and Sudano1 suggest that there is a sharp decline in the probability of being uninsured as the cohort aged 51 to 57 years approaches age 65 years. However, the stable nationally representative estimates from the CPS suggest that their claim is most likely an artifact of the differential dropout by insurance status in the HRS. While the overall rate of loss to follow-up is 7.4% in 1994 (as reported by Sudano and Baker1), we estimated this rate to be 6.7% among the insured and 13.8% among the uninsured. This dropout pattern continues in all survey waves and is not accounted for in HRS survey weights. Hence, one must account for this differential dropout in the HRS when using this survey to generate national estimates of health insurance coverage in this age cohort. Correspondence: Dr Polsky, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Blockley Hall, Room 1212, 423 Guardian Dr, Philadelphia, PA 19104 (polsky@mail.med.upenn.edu). References 1. Baker DWSudano JJ Health insurance coverage during the years preceding Medicare eligibility. Arch Intern Med 2005;165770- 776PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 28, 2005

Keywords: follow-up,insurance coverage,medical insurance coverage,hrs trial

References