{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:38:18Z","timestamp":1791041898303,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL164561"],"award-info":[{"award-number":["R01HL164561"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL148525"],"award-info":[{"award-number":["K23HL148525"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the effects of Medicare eligibility and enrollment on the use of high\u2010value and low\u2010value care services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>The 2002\u20132019 Medical Expenditure Panel Survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We employed a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65\u2009and compares individuals just before and after age 65. Our primary outcomes included the use of high\u2010value care services (eight services) and low\u2010value care services (seven services). To examine the effects of Medicare eligibility, we conducted a regression discontinuity analysis. To examine the effects of Medicare enrollment, we used the discontinuity in the probability of having Medicare coverage around the age eligibility cutoff and conducted an instrumental variable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>N\/A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Medicare eligibility and enrollment led to statistically significant increases in the use of only two high\u2010value services: cholesterol measurement [2.1 percentage points (95%: 0.4\u20133.7) (2.2% relative change) and 2.4 percentage points (95%: 0.4\u20134.4)] and receipt of the influenza vaccine [3.0 percentage points (95%: 0.3\u20135.6) (6.0% relative change) and 3.6 percentage points (95%: 0.4\u20136.8)]. Medicare eligibility and enrollment led to statistically significant increases in the use of two low\u2010value services: antibiotics for acute upper respiratory infections [6.9 percentage points (95% CI: 0.8\u201313.0) (24.0% relative change) and 8.2 percentage points (95% CI: 0.8\u201315.5)] and radiographs for back pain [4.6 percentage points (95% CI: 0.1\u20139.2) (36.8% relative change) and 6.2 percentage points (95% CI: 0.1\u201312.3)]. However, there was no significant change in the use of other high\u2010value and low\u2010value care services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medicare eligibility and enrollment at age 65\u2009years led to increases in the use of some high\u2010value and low\u2010value care services, but there were no changes in the use of the majority of other services. Policymakers should consider refining the Medicare program to enhance the value of care delivered.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14065","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T08:39:14Z","timestamp":1663231154000},"page":"174-185","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Effects of Medicare eligibility and enrollment at age 65\u2009years on the use of h<scp>igh\u2010value<\/scp> and l<scp>ow\u2010value<\/scp> care"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7546-9685","authenticated-orcid":false,"given":"Sungchul","family":"Park","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management College of Health Science, Korea University, BK21 FOUR R&amp;E Center for Learning Health Systems, Korea University  Seongbuk\u2010gu, Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi K.","family":"Wadhera","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7574-0677","authenticated-orcid":false,"given":"Jeah","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Policy College of Health and Human Services, George Mason University  Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.00940"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.98.5.2242"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa067712"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.6.757"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1162\/qjec.2009.124.2.597"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.24.2886"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/716544"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.2531"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1086\/706623"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1257\/pol.20140262"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.8268"},{"key":"e_1_2_11_13_1","unstructured":"Centers for Medicare and Medicaid Services.Value\u2010based programs. 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