The impact of health insurance on health.

Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA.
Annual Review of Public Health (Impact Factor: 6.63). 02/2008; 29:399-409. DOI: 10.1146/annurev.publhealth.28.021406.144042
Source: PubMed

ABSTRACT How does health insurance affect health? After reviewing the evidence on this question, we reach three conclusions. First, many of the studies claiming to show a causal effect of health insurance on health do not do so convincingly because the observed correlation between insurance and good health may be driven by other, unobservable factors. Second, convincing evidence demonstrates that health insurance can improve health measures of some population subgroups, some of which, although not all, are the same subgroups that would be the likely targets of coverage expansion policies. Third, for policy purposes we need to know whether the results of these studies generalize. Solid answers to the multitude of important questions about how specific health insurance policy options may affect health seem likely to be forthcoming only with investment of substantial resources in social experiments.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the impact of the insurance expansion in 2006 on use of knee and hip replacement procedures by race/ethnicity, area income, and the use of hospitals that predominantly serve poor people ("safety net hospitals"). Quasi-experimental difference in differences study examining change after reform in the share of procedures performed in safety net hospitals by race/ethnicity and area income, with adjustment for patients' residence, demographics, and comorbidity. State of Massachusetts, United States. Massachusetts residents aged 40-64 as the target beneficiaries of reform and similarly aged residents of New Jersey, New York, and Pennsylvania as the comparison (control) population. Number of knee and hip replacement procedures per 10 000 population and use of safety net hospitals. Procedure counts from state discharge data for 2.5 years before and after reform, and multivariate difference in differences. Poisson regression was used to adjust for demographics, economic conditions, secular time, and geographic factors to estimate the change in procedure rate associated with health reform by race/ethnicity and area income. Before reform, the number of procedures (/10 000) in Massachusetts was lower among Hispanic people (12.9, P<0.001) than black people (28.1) and white people (30.1). Overall, procedure use increased 22.4% during the 2.5 years after insurance expansion; reform in Massachusetts was associated with a 4.7% increase. The increase associated with reform was significantly higher among Hispanic people (37.9%, P<0.001) and black people (11.4%, P<0.05) than among white people (2.8%). Lower income was not associated with larger increases in procedure use. The share of knee and hip replacement procedures performed in safety net hospitals in Massachusetts decreased by 1.0% from a level of 12.7% before reform. The reduction was larger among Hispanic people (-6.4%, P<0.001) than white people (-1.0%), and among low income residents (-3.9%, p<0.001) than high income residents (0%). Insurance expansion can help reduce disparities by race/ethnicity but not by income in access to elective surgical care and could shift some elective surgical care away from safety net hospitals. © Hanchate et al 2015.
    BMJ Clinical Research 02/2015; 350:h440. DOI:10.1136/bmj.h440 · 14.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The mutual health insurance (Mutuelle de Santé) system in Rwanda is one of the most extensive community based health insurance schemes operated in Sub-Saharan Africa covering over 90 per cent of the population. Several studies, so far, have documented the success of the Mutuelle de Santé in addressing the two prime objectives of health insurance in a low-income setting, namely to increase access to health care and to reduce the burden of catastrophic health spending particularly for the poorer groups of society. This paper builds on these earlier works on the Mutuelle de Santé but despite considering the overall population, it aims to provide more detailed insights on the effects of the Mutuelle by concentrating on the role of mutual health insurance coverage for child health. In order to identify the effect of health insurance enrolment on measures of care and health we propose an instrumental variable approach. The analysis in this paper is based on data from the 2010 Rwandan Demographic and Health Survey (RDHS) and administrative records on insurance coverage and health facility infrastructure. Overall, our results do confirm the positive perceptions and show that Mutuelle enrolment increases the probability of small children receiving medical treatment when ill. Furthermore, we also find a positive effect on children's health status documented through improvements in height-for-age z-scores. Unlike some studies from other contexts do we not find any indications that insurance coverage leads households to reduce preventative measures, quite to the contrary, our results rather suggest that insured households are more precautionary.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A lack of health insurance has long been associated with negative effects on individual and family health due to access barriers. However, we know little about how a lack of health insurance affects wider communities beyond health care. Based on in-depth interviews in two Los Angeles communities, we report how a lack of health insurance affects the functioning of religious institutions and schools from kindergarten to 12th grade. We find a negative spillover effect at the individual and institutional levels for schools experiencing greater absenteeism due to health insurance problems of pupils. However, we find that religious organizations are little affected by a lack of health insurance of adherents. Instead, churches offer health programs as a means to engage their communities. Besides documenting a negative and a positive spillover effect, we offer a conceptual framework for the qualitative study of health spillover effects and examine the policy implications of our findings.
    Journal of Health and Social Behavior 09/2014; 55(3):360-74. DOI:10.1177/0022146514543523 · 2.72 Impact Factor