As debates about health care reform and adequate access to insurance coverage continue, knowing what past research has found when it comes to the effects of insurance on economic and health outcomes becomes increasingly important.
According to a comprehensive literature review led by Etienne Gaudette, some specific groups benefit more than others from access to health insurance. In particular, health insurance does have important and broad positive effects for low-income children and vulnerable adults. Gaudette is a health economist at the USC Keck-Schaeffer Initiative for Population Health Policy and the USC Schaeffer Center for Health Policy & Economics.
Gaudette and his colleagues Gwyn Pauley and Julie Zissimopoulos reviewed and synthesized over 100 studies that examined the effects of health insurance on individuals in early and mid-life (i.e., at ages most relevant to current debates about health care reform). Studies included in the review met the standard for a rigorous study design that measured the causal impact of insurance: randomized experiments, regression discontinuity design, instrumental variables analysis, or difference-in-difference experiments. They evaluated outcomes across economic, financial, health, and medical predictors which they organized into 14 broad economic and health categories.
Their review, published in Medical Care Research and Review is the first review and synthesis that considers both the economic and the health impacts of health insurance.
The studies the researchers reviewed examined impacts across seven types of economic outcomes: labor force participation, earnings, wages, government program participation, education, savings and asset accumulations, household finances, and delayed care due to costs. Highlights across the studies include:
- Access to health insurance affected the labor supply of vulnerable groups including single mothers, pregnant women, and sick adults. In particular, health insurance has been shown to increase labor force participation of single mothers while decreasing participation for pregnant women. Studies of subsets of less healthy adults found that these individuals were responsive to health insurance.
- Health insurance has been linked to improved education outcomes.
- Insured individuals were less likely to delay care due to costs.
Health measurements linked to health insurance coverage identified in the studies included indicators on mortality, self-reported health status, prevalence of risk factors, health limitations and functional status, preventable hospitalizations, incidence/prevalence and outcomes of chronic conditions, and mental health diagnosis and outcomes. Trends the researchers found included:
- The health of low-income children from public insurance coverage benefited in terms of reductions in ambulatory care-sensitive hospitalizations, improved indicators of overall health, and lower incidence of some chronic conditions.
- Adults from lower socioeconomic status and adults in poor health showed health benefits from insurance coverage in terms of improved mortality, functional status, and blood pressure management.
- Insurance was linked to improved mental health status for low-income adult population affected by health insurance reforms.
This review highlights the heterogeneous effects of health insurance coverage: though coverage has been shown to impact specific populations, benefits from insurance coverage were largely mixed or not found when assessing the general adult population.
Gaudette and his colleagues point to a number of areas that would benefit from additional research including the relationship between health insurance and government program participation, particularly the long-term effects of insurance on government program take-up later in life. In addition, the authors noted that much of the literature compared being insured to being uninsured, and did not take into account the type of insurance included in the study. Given the increased uptake of high deductible health insurance plans, more research is needed about the importance of health insurance design and quality on outcomes.
The full review can be accessed here.
Zissimopoulos is the director of education at the USC Schaeffer Center for Health Policy & Economics and a professor and vice dean for academic affairs at the USC Price School of Public Policy. Pauley is a fellow at the USC Schaeffer Center and a visiting assistant professor at the University of Wisconsin-Madison.