ues in the HMS Department of Health Care Policy, conducted a study comparing previously uninsured to insured adults to see how each group used health services before and after entering Medicare.

Using data from a national survey, the Health and Retirement Study, the researchers followed 5,158 adults who were ages 53 to 61 in 1992 for 12 years (through 2004). They compared health care use and expenses for 3,773 subjects who were insured and 1,385 who were uninsured before 65. The survey also captured information on dozens of different characteristics, from subjects exercise habits to depression symptoms.

To account for the large differences between insured and uninsured adults in characteristics such as education and income levels, the researchers gave more statistical weight to insured subjects who closely resembled the uninsured group in education, income, and other characteristics than they did to insured subjects who were very different.

When the researchers compared these statistically similar groups, the differences due to insurance were clear. After gaining Medicare coverage at age 65, health care use by previously uninsured adults not only rose to the level of previously insured adults but exceeded it substantially, says McWilliams. These greater health care needs persisted at least through age 72.

These findings were especially noticeable in adults with cardiovascular disease or diabetes, illnesses that can be life-threatening when left untreated, but manageable if caught early. This is a group for whom medical advances in recent decades have had an impressive impact on health. If people with diabetes, hypertension, or heart disease are uninsured, they often have to forego very cost-effective therapies, says McWilliams.

Providing health insurance coverage for uninsured near-elderly adults may not only improve their health, but also reduce their annual health care use after age 65, he con
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