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The impact of Medicare Part D on self-employment. (Moulton et al. 2017)

Review Guidelines

Absence of conflict of interest.

Citation

Moulton, J. G., Diebold, J. C., & Scott, J. C. (2017). The impact of Medicare Part D on self-employment. Research on Aging, 39(1), 64-85.

Highlights

  • The study examined the effect of the introduction of Medicare Part D on self-employment. The authors used a nonexperimental approach and data from the American Community Survey to estimate the impact.
  • The authors found that self-employment significantly increased by 0.5 percentage points after the program began.
  • The quality of causal evidence presented in this report is moderate because it was based on a well-implemented nonexperimental design. This means we are somewhat confident that the estimated effects on self-employment are attributable to the introduction of Medicare Part D, although other factors might also have contributed.

Intervention Examined

Medicare Part D

Features of the Intervention

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established Part D, which was implemented in 2006 and allowed eligible people ages 65 and older to substitute their existing prescription drug coverage with a Part D plan instead of a plan offered through Medicaid, an employer, or a privately purchased plan.

Features of the Study

The authors used regression models (difference-in-differences approach) to compare the changes in self-employment between those who were eligible for Medicare (ages 65 to 69 years old) and those who were not eligible (ages 60 to 64 years old) following the implementation of Part D. The authors used data from the American Community Survey from 2001 to 2013 for those ages 60 to 69 years old, which included a total sample size of 3,078,117 people.

Findings

Employment

  • The authors found that self-employment significantly increased by 0.5 percentage points after the program began.

Considerations for Interpreting the Findings

Although the authors use a well-implemented nonexperimental design, it is difficult to disentangle the effects of the Great Recession on self-employment.

Causal Evidence Rating

The quality of causal evidence presented in this report is moderate because it was based on a well-implemented nonexperimental design. This means we are somewhat confident that the estimated effects on self-employment are attributable to the introduction of Medicare Part D, although other factors might also have contributed.

Reviewed by CLEAR

September 2019

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