THE IMPACT OF HEALTH INSURANCE ON PREVENTIVE CARE AND HEALTH BEHAVIORS: EVIDENCE FROM THE FIRST TWO YEARS OF THE ACA MEDICAID EXPANSIONS
THE IMPACT OF HEALTH INSURANCE ON PREVENTIVE CARE AND HEALTH BEHAVIORS: EVIDENCE FROM THE FIRST TWO YEARS OF THE ACA MEDICAID EXPANSIONS
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DOI：
10.1002/pam.21972
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发表时间：
2017-03-01
影响因子：
3.8
通讯作者：
Cawley, John
中科院分区：
文献类型：
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作者：
Simon, Kosali;Soni, Aparna;Cawley, John
美国人口接受的预防保健水平不佳，危险健康行为的流行率很高。《平价医疗法案》（ACA）的一个目标是通过扩大医疗保险的覆盖面来增加预防性医疗和改善健康行为。本文估计了2014年ACA促进的州一级医疗补助扩张如何影响这些结果。使用来自行为风险因素监测系统的数据，以及一个比较扩大和没有扩大医疗补助的州的差异模型，我们研究了扩大对预防保健的影响（例如，牙科就诊、免疫接种、乳房X线照片、癌症筛查），危险的健康行为（例如，吸烟、酗酒、缺乏锻炼、肥胖）和自我评估的健康状况。我们发现，扩大增加了保险覆盖面和获得照顾的目标人群低收入无子女的成年人。扩张也增加了某些形式的预防性护理的使用，但没有证据表明它们增加了事前道德风险（即，没有证据表明，健康保险覆盖范围增加了危险的健康行为）。医疗补助的扩大也适度改善了自我评估的健康状况。(C)2017年，公共政策分析与管理协会。
The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health. (C) 2017 by the Association for Public Policy Analysis and Management.