The Causal Effect of Health Insurance on Utilization and Outcomes in Adults A Systematic Review of US Studies
The Causal Effect of Health Insurance on Utilization and Outcomes in Adults A Systematic Review of US Studies
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DOI：
10.1097/mlr.0b013e318185c913
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发表时间：
2008-10-01
期刊：
影响因子：
3
通讯作者：
Martin, Diane P.
中科院分区：
文献类型：
--
作者：
Freeman, Joseph D.;Kadiyala, Srikanth;Martin, Diane P.
背景：目前对于获得或失去健康保险对医疗保健利用和健康结果的因果影响尚无共识。目的：系统地搜索和审查健康保险对美国非老年人的医疗保健利用和/或健康结果的估计因果影响的现有证据。研究设计：对 3 个电子数据库（PubMed.JSTOR.EconLit）进行了系统搜索。要纳入审查，研究的发表日期必须在 1991 年之后；非老年人口；分析比较未投保组与适当的对照组；解释潜在反向因果关系并提供因果效应估计的 3 个研究设计中的 1 个（纵向队列、工具变量分析或准实验设计）。 结果：对总共 9701 项研究（包括重复项）进行了初步筛选。 14 项研究符合纳入本次综述的标准——4 项使用标准回归或固定效应分析的纵向队列研究，5 项使用工具变量回归分析的纵向队列研究，以及 5 项准实验研究。 结论：我们对估计健康保险与医疗保健利用和/或健康结果之间因果关系的实证研究的审查结果一致表明，健康保险提高了利用率并改善了健康。具体而言，健康保险对医生服务的使用、预防服务、自我报告的健康状况以及因受伤和疾病而导致的死亡率具有重大影响。这些结果既证实又反驳兰德健康保险实验的可比结果，兰德健康保险实验是健康保险、利用和健康之间关系的黄金标准。
Background: No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes.Objective: To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States.Research Design: A systematic search of 3 electronic databases (PubMed. JSTOR. EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design).Results: A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review-4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies.Conclusion: Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.