We study the effect of Medicare on financial strain, measured by annual changes in medical debt in collections, using credit bureau data. We exploit the program’s eligibility age at 65 and compare the experiences of those just under and over age 65 using a regression discontinuity design. We find that during our baseline study period Medicare reduced the annual probability of large medical collections, above $1,000, by 0.31 percentage points, a 19 percent reduction relative to the probability for those aged 60–64, and reduced new medical collections by approximately $380 at the 99th percentile, a 23 percent decrease. We hypothesize that Medicare mainly decreases medical collections among those who transition from uninsured to Medicare. Under that hypothesis we estimate a “treatment on the treated” average reduction of about $250 in new medical collections. We find support for our hypothesis by comparing discontinuities for those in zip codes with different uninsured rates pre-age 65, and comparing discontinuities before and after implementation of the main health insurance provisions of the Affordable Care Act. Our findings complement recent work on the role of Medicare in reducing risk of out-of-pocket medical expenditures and of health insurance in reducing medical collections.

中文翻译：

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医疗保险会减少医疗债务吗？

我们使用征信局的数据，研究了医疗保险对财务压力的影响，衡量方法是通过收款中医疗债务的年度变化来衡量。我们利用该计划的65岁年龄段资格，并使用回归不连续性设计比较65岁以下和65岁以上年龄段人群的经验。我们发现，在我们的基准研究期间，Medicare降低了超过$ 1,000的大额医疗收款的年度概率降低0.31个百分点，相对于60-64岁年龄段的概率降低了19％，并且在第99个百分点，下降了23％。我们假设Medicare主要减少了那些从未投保过渡到Medicare的人的医疗费用。在该假设下，我们估计新医疗产品的“治疗后治疗”平均减少约250美元。我们可以通过比较邮递区号65之前的不同未保险费率的不连续性，并比较《平价医疗法案》主要健康保险条款实施前后的不连续性，来支持我们的假设。我们的发现补充了有关Medicare在减少自付费用医疗支出风险以及健康保险在减少医疗收支方面的作用的最新工作。