Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?

Despite important impacts on financial protection, there is only mixed evidence that Medicare improves health on the population-level. However, small average effects on health the population-level may mask larger effects on health for policy-relevant sub-populations, such as patients with high mortality risk and urgent need for medical care. We study a group of people for whom access to health insurance could have plausible, immediate impacts on health – people with cancer. We use a regression discontinuity design to assess impacts of near-universal Medicare insurance at age 65 using population-based cancer registries and vital statistics data. At age 65, cancer detection increased by 11 per 100,000 population and cancer mortality decreased by 7 per 100,000 population for tumor sites with recommended screening. Multiple checks, including comparison with data from Canada as a placebo check, suggested the robustness of findings, while evidence on increases in cancer screening at age 65 from the Behavioral Risk Factor Surveillance System suggests one channel underlying the findings. This study provides the first evidence to our knowledge that access to Medicare is associated with improvements in population-level cancer mortality.