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Jumping to Conclusions: Will Expanding Health Care Insurance
Improve the Health of the Uninsured?
THE PROBLEM
Hundreds of studies document that people without health insurance have
worse outcomes than those with health insurance. Is this evidence enough
to conclude that having health insurance would improve the health of the
uninsured?
A review of the research, conducted for The Economic
Research Initiative on the Uninsured (ERIU) at the University of Michigan
by University of Chicago health economists Helen Levy, Ph.D., and David
Meltzer, M.D., Ph.D., reveals that the vast majority of the studies examining
the extent to which health insurance can improve health outcomes cannot
determine a causal effect because they don't adequately control for other
key factors, such as age or income, that may contribute to health status.
Only a handful of studies have been designed to show such a causal relationship
between health insurance and improved health, while most research merely
suggests a correlation exists.
Although extending health insurance can help people
access medical care, researchers need to delve deeper to better understand
how having health insurance compares to other interventions that can affect
health, such as wider access to public health clinics, immunizations,
initiatives to curb obesity, and programs to reduce socioeconomic inequities.
This will allow policymakers to consider the value of health insurance
relative to other interventions that could improve health, and avoid unnecessarily
costly and misguided policy interventions that do not best improve health.
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"Expanding health insurance
is an important policy solution but it fails to get at the root causes
of poor health status among some uninsured individuals. As a group,
people without health insurance are less healthy than people with
coverage, but poor health status is not always attributable to being
uninsured. Consequently, interventions other than, or in addition
to, insurance expansions may be the most efficient way to improve
the health of uninsured individuals. For example, using public dollars
to address America's obesity epidemic among school-aged children by
subsidizing school lunches and offering more nutritious choices may
be a more efficient way to improve the health of uninsured young people.
Supporting educational, social, and therapy programs designed to temper
rates of drinking, smoking and other high-risk behavior among teenagers
may be more effective in improving their health status. Before debating
how to make the best use of limited resources, policymakers need better
research on the relative contribution of various determinants of health
disparities."
From Catherine McLaughlin, Ph.D., Professor at the University
of Michigan and Director of ERIU |
THE FACTS
- Access to medical care through insurance is one of many factors
determining health status. Other indicators include age, stress,
income, education level, health behaviors, beliefs about Western medicine,
and genetic predisposition to disease.
- Correlation does not mean causation. Of nearly 1,000 studies
showing that people without health insurance have worse health status
than those with insurance, less than a dozen are designed in a way to
determine if the relationship is causal.
- Insurance expansion benefits children, elderly. The few studies
designed to determine such a causal relationship show that health improvements
have occurred for children and seniors under policies that have expanded
Medicaid, children's health, and Medicare coverage. But evidence is
lacking that health insurance improves the health of non-elderly adults.
Click
here for full Q&A with David Meltzer,M.D.,Ph.D.
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UPCOMING
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| This Research Highlight is the
second in a series of research-based policy documents that will address
current questions and issues related to the health care coverage debate.
The next Research Highlight will examine what leads some employers
to offer and some workers to take employment-based health insurance.
Research Highlights can be found on ERIU’s website at . |
Click here for other ERIU Research Highlights
Click here for the full paper (Adobe PDF)
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Funded by The Robert Wood Johnson Foundation, ERIU is a
five-year program shedding new light on the causes and consequences of
lack of coverage, and the crucial role that health insurance plays in
shaping the U.S. labor market. The Foundation does not endorse the findings
of this or other independent research projects.
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