Open Access Dissertation
Date of Award
This dissertation seeks to examine the economic determinants of the use of preventive services among older adults. It contains two studies that focus on the effects of public health policy and health shocks on the initiation of use of preventive services among older adults.
In January 2005, Medicare began covering a one-time initial preventive physical examination (IPPE), also called a "Welcome to Medicare" visit, for new beneficiaries. This benefit was only available during a beneficiary's first six months after enrolling in Part B. The first study examines the effects of covering an IPPE on the use of mammograms, breast self-exams, Pap smears, prostate cancer screenings, cholesterol screenings, and flu vaccines among beneficiaries new to Medicare Part B. Using data from the 1996-2008 Health and Retirement Study (HRS) and the RAND HRS, I estimate multivariate logit models to quantify the effects of Medicare coverage of an IPPE on the utilization of each of these preventive care services. The findings indicate that, among both men and women, the introduction of Medicare IPPE coverage during a beneficiary's first six months under Part B did not increase the utilization of any of the preventive services examined.
Although about 70% of older adults will have one chronic condition and 50% will have more than one chronic illness such as heart disease, cancer, stroke, etc. (CDC 2009), only 25% of adults ages 50-64, and fewer than 40% of adults ages 65 and older are up-to-date on recommended preventive healthcare services. The second study evaluates whether new information, acquired through the occurrence of unexpected adverse health events, leads an individual to begin using preventive care services. Using data from the longitudinal Health and Retirement Study (HRS) and the RAND HRS, multivariate logit models are estimated to model the dynamic effects of exogenous health shocks on the initiation of use of mammograms, breast self-exams, Pap smears, prostate cancer screening, cholesterol tests, and flu vaccinations. Findings reveal that among adults with a history of not using preventive care, an unexpected adverse health event often spurs them to begin using such services. Among women ages 40 and older, those who experience an adverse health shock are 1.87 times more likely to begin getting mammograms, 1.48 times more likely to begin getting Pap smears, 1.79 times more likely to begin getting cholesterol tests, and 1.46 times more likely to begin getting flu vaccinations. Among men ages 40 and older, those who experience an adverse health shock are 2.24 times more likely to begin getting prostate cancer screenings, 2.75 times more likely to begin getting cholesterol checks, and 1.64 times more likely to begin getting flu vaccinations. These findings provide strong evidence that people change their health behaviors in positive ways following the occurrence of a negative health experience.
Ng, Boon Peng, "Economic Analysis Of Preventive Care Utilization Among Older Adults" (2014). Wayne State University Dissertations. 971.