The Effect of Private Insurance on the Health of Older, Working Age Adults: Evidence from the Health and Retirement Study (original) (raw)
Related papers
2003
In this paper we investigate whether the presence of private insurance leads to improved health status. Using the Health and Retirement study we focus on adults in late middle age who are nearing entry into Medicare. Estimation addresses endogeneity of the insurance participation decision in health outcome regressions. Two models are tested, an instrumental variables models, and a model with endogenous treatment effects due to Heckman (1978). Insurance participation and health behaviors enter with a lag to allow their effects to dissipate over time. Separate regressions were run for groupings of chronic conditions. We find that the overall impact of insurance on health tends to be significantly downwards biased if no adjustment for endogeneity is made. With corrections there is a four-fold increase in the insurance effect; yielding a 7 percent increase in the overall health measure for the uninsured. Results are consistent across IV and treatment effects models, and for all major groupings of medical conditions. Thus, the effect of private insurance on health may be larger than previously estimated. As for policy, expanding coverage to the uninsured should result in substantial health improvement. By conjecture, this is likely to reduce the need for health care when individuals retire and enter Medicare, potentially leading to savings.
The Impact of Health Insurance on Health
Annual Review of Public Health, 2008
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.
The Effect of Health Insurance Coverage on the Use of Medical Services
American Economic Journal: Economic Policy, 2012
Substantial uncertainty exists regarding the causal effect of health insurance on the utilization of care. Most studies cannot determine whether the large differences in healthcare utilization between the insured and the uninsured are due to insurance status or to other unobserved differences between the two groups. In this paper, we exploit a sharp change in insurance coverage rates that results from young adults "aging out" of their parents' insurance plans to estimate the effect of insurance coverage on the utilization of emergency department (ED) and inpatient services. Using the National Health Interview Survey (NHIS) and a census of emergency department records and hospital discharge records from seven states, we find that aging out results in an abrupt 5 to 8 percentage point reduction in the probability of having health insurance. We find that not having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely to reductions in the care provided by privately owned hospitals, with particularly large reductions at for profit hospitals. The results imply that expanding health insurance coverage would result in a substantial increase in care provided to currently uninsured individuals.
Health insurance coverage among the elderly
1994
The research reported in this paper examines the decision to have private health insurance by elderly Medicare enrollees. Models allowing both stimultaneity and a joint error structure between health insurance and use of medical care are considered. We find that common unobserved variables underlying the joint errors are important determinants in the decision to purchase private health insurance. Simultaneity is present only between the decision to have private health insurance and the probability of visiting a doctor. Health status and functional limitations are important determinants of the decision to have private health insurance in addition to Medicare coverage. Other personal characteristics (age, sex, race and education), as well as household income, Medicaid enrollment, and the employment of a family member are also found to be related to the decision to have private health insurance.
Private Health Insurance Coverage and Disability among Older Americans
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 1998
Objectives. This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and older. Methods. Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. Results. Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. Discussion. The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.
The Cost Effectiveness of Health Insurance
Background: Although studies have examined both the adverse consequences of lacking health insurance and the costs of insuring the uninsured, there are no estimates of the value of providing health insurance to those currently uninsured. Objective: To examine the value associated with providing insurance to those currently uninsured through an incremental cost-effectiveness analysis. Methods: People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality follow-up) and the Medical Expenditure Panel Survey were examined to estimate the contribution of sociodemographic, health, and health behavior characteristics on insured persons' quality-adjusted life years (QALYs) and healthcare costs. Parameter estimates from these regression models were used to predict QALYs and costs associated with insuring the uninsured, given their characteristics for 1996. Markov decision-analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness of insurance for the average 25-year-old adult (through age 64) is approximately 35,000perQALYgained(range35,000 per QALY gained (range 35,000perQALYgained(range21,000 to $48,000). The incremental cost-effectiveness ratio becomes more favorable as people approach age 65. Conclusions: The additional health care purchased with health insurance provides gains in quality-adjusted life at costs that compare favorably to those of other programs and medical interventions society now chooses to fund. (Am J Prev Med 2005;28(1):59 – 64)
Older Adults and Their Health Insurance
The health insurance coverage of older adults is an increasingly important public policy issue, as private employers cut back on their coverage of retired workers by a variety of methods. The issue has received heightened attention because of a 1998 proposal by the Clinton Administration to provide a Medicare buy-in for older adults.
The Impact of Health Insurance Status on Treatment Intensity and Health Outcomes
2007
This paper uses the abrupt changes in health insurance coverage at age 65 arising from the Medicare program eligibility rules to evaluate the impact of insurance status on treatment intensity and health outcomes. Drawing from several million hospital discharge records for the State of California, we begin by identifying a subset of patients who are admitted through the emergency room for non-deferrable conditions-diagnoses with the same daily admission rates on weekends and weekdays. Among this subset of patients there is no discernable rise in the number of admissions at age 65, suggesting that the severity of illness is similar for patients who are just under 65 and those who are just over 65. The fraction of patients in this group who lack health insurance, however, falls sharply at age 65, while the proportion with Medicare as their primary insurer rises. Tracking health-related outcomes of the group, we find significant increases in treatment intensity at the age 65 barrier, including increases in the number of procedures performed, and total list charges. We also find a rise in the probability that patients are transferred to other units within the same hospital, coupled with a reduction in the probability of discharge to home. Finally, we estimate a drop in the rate of re-admission within one month of the initial discharge.
Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors
The Journal of the American Board of Family Medicine, 2013
Background: Economists posit 2 mechanisms increasing financial risk to insurers after health insurance gain: ex ante moral hazard (riskier behavior because of reduced personal costs) and ex post moral hazard (increased use of care because of lower care costs). In contrast, the Health Belief Model (HBM), would anticipate no increase in risk behaviors while also predicting increased health care utilization following insurance gain (because of reduced financial barriers to accessing care). Empirical studies examining the association of insurance change with changes in preventive care and health behaviors have been limited and yielded mixed findings. The objective of this study was to examine the association of health insurance change (gain or loss of coverage) with changes in preventive care and health behaviors in a large, nationally representative sample. Methods: We analyzed data from adults >18 years old and enrolled for 2 years in the 2000 to 2009 Medical Expenditure Panel Surveys (n ؍ 76,518). Conditional logistic regression analyses modeled year-to-year individual changes in preventive care and health behaviors associated with individual changes in insurance status, adjusting for characteristics varying year to year (income, employment, total health care expenditures, office visits, prescriptions, availability of usual source of care, and health status). Preventive care included adherence to influenza vaccination, colorectal cancer screening, mammography, and Papanicolaou and prostate-specific antigen testing. Health behaviors examined were becoming nonobese, quitting smoking, and adopting consistent use of seatbelts. Results: Insurance gain (loss) was associated with increases (decreases) in preventive care (adjusted odds ratios [95% confidence intervals]: influenza vaccine, 1.27 [1.04-1.56]; colorectal cancer screening, 1.48 [0.96-2.29]; Papanicolaou testing, 1.56 [1.22-2.00]; mammography, 1.70 [1.21-2.38]; prostate-specific antigen, 1.42 [0.98-2.05]). Insurance change was not associated with significant changes in health behaviors. Conclusions: Consistent with both economic theory and the HBM, preventive care increased (decreased) after gaining (losing) coverage. In contrast, health behaviors changed little after insurance change, consistent with the HBM but not with the potential for decreased personal health care costs (ex ante moral hazard).