Medicare and Fruit and Vegetable Consumption in Hypertensive Adults Aged 55–75: A Regression Discontinuity Study

Abstract

ObjectivesHypertension affects nearly 75% of U.S. adults 65 or older. Along with medical care, lifestyle interventions such as diet and physical activity have been recommended to treat hypertension. Medicare, a federal health insurance program for people 65 or older, increases health care utilization among beneficiaries with chronic conditions. However, the effect of Medicare on lifestyle behaviors is yet to be understood. Whereas Medicare could alleviate the out-of-pocket health care expenses and allow increased spending on healthy foods, the coverage might disincentivize adherence to a healthy diet in some individuals. The objective is to assess the effects of Medicare on fruit and vegetable consumption in a nationally representative sample of US hypertensive adults aged 55–75. MethodsData from the 2013–2018 National Health and Nutrition Examination Survey (NHANES), were used. The current study included 2,806 respondents 55–75 years of age diagnosed with hypertension who completed the first-day diet recall. Because age is the determining factor for Medicare eligibility, a regression discontinuity design (RDD) was used to assess the effect of Medicare on the number of daily servings of fruit and vegetables consumed. Demographic variables namely sex, race, education, income level, marital status, health insurance status, and medical conditions were covariates. ResultsThe mean ± SD age was 64.61 y ± 5.62 and 51.82% were female. 82% of those aged 65–75 had Medicare. On average, the respondents consumed 3.63 servings of fruits and 7.14 servings of vegetables. In the RDD, Medicare did not lead to a statistically significant reduction in fruit consumption (bandwidth of 55–75: B = –0.604; p-value = 0.710; bandwidth of 59–71: B = –0.593; p-value = 0.516) or vegetable consumption (bandwidth of 55–75: B = 0.260; p-value = 0.829; bandwidth of 59–71: B = 0.261; p-value = 0.829) among hypertensive patients. The results did not substantially alter after employing different model specifications. ConclusionsThe findings of this study include key policy implications. Since Medicare has no substantial effect on fruit and vegetable consumption and overall healthy behaviors, policy interventions are needed to complement Medicare with improving healthy behavior programs. Funding SourcesN/A.