Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors
Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors
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DOI：
10.3122/jabfm.2013.06.130054
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发表时间：
2013-11-01
影响因子：
2.9
通讯作者：
Franks, Peter
中科院分区：
文献类型：
--
作者：
Jerant, Anthony;Fiscella, Kevin;Franks, Peter
背景资料：经济学家分析了在获得医疗保险后增加保险公司财务风险的两种机制：事前道德风险（由于个人成本降低而导致的风险行为）和事后道德风险（由于医疗成本降低而导致的医疗使用增加）。相比之下，健康信念模型（HBM）预计风险行为不会增加，同时还预测保险收益后医疗保健利用率会增加（因为获得医疗保健的财务障碍减少）。检验保险变化与预防保健和健康行为变化之间关系的实证研究有限，结果好坏参半。本研究的目的是检查协会的健康保险的变化（收益或损失的覆盖范围）与预防保健和健康behaviors.Methods的变化，在一个大的，全国代表性的样本：我们分析了数据，从成年人≥ 18岁，在2000年至2009年的医疗费用面板调查（n = 76,518），登记为2年。条件Logistic回归分析模拟了与保险状况个人变化相关的预防保健和健康行为的逐年变化，调整了逐年变化的特征（收入，就业，总医疗保健支出，办公室访问，处方，常用护理来源的可用性和健康状况）。预防性护理包括坚持流感疫苗接种、结直肠癌筛查、乳房X光检查、巴氏涂片和前列腺特异性抗原检测。健康行为检查是成为非肥胖，戒烟，并采取一贯使用安全带。预防性保健（减少）（调整优势比[95%置信区间]：流感疫苗，1.27 [1.04-1.56];结直肠癌筛查，1.48 [0.96-2.29];巴氏试验，1.56 [1.22-2.00];乳房X线摄影，1.70 [1.21-2.38];前列腺特异性抗原，1.42 [0.98-2.05]）。保险变化与健康behaviors.Conclusions的显着变化不相关：符合经济理论和HBM，预防保健增加（减少）后获得（失去）覆盖。相比之下，保险变更后健康行为变化不大，与HBM一致，但不具有降低个人医疗保健成本的潜力（事前道德风险）。
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).