7 - How Health Insurance Affects Health

项目摘要/摘要 项目7--医疗保险如何影响健康 了解医疗保险覆盖范围的后果对于评估扩大或 修改美国的医疗保险覆盖范围。但关于这一影响，几乎没有令人信服的证据 对未参保者的医疗使用、健康结果、健康行为或整体福利进行保险， 很大程度上是因为参加健康保险是一种与其他决定因素共同做出的选择 这些结果。 这个项目利用了一个难得的机会来提供这样的证据。对于有限的窗口 2008年初，俄勒冈州为低收入者开设了公共医疗保险计划的等待名单 然后从名单中随机抽取名字，以确定谁将有机会注册。 这种独特的政策环境为研究人员提供了一个难得的机会来带来随机的优势 任务--医学试验的标准--解决一个关键的社会政策问题。这项建议建立了 关于我们先前评估医疗补助对医疗保健使用、健康和福祉的影响的工作，包括 重点关注健康风险在许多方面与65岁相似的近老年人(50岁-) 以及那些很快就会变老为联邦医疗保险的人。我们发现，医疗补助大幅增加 跨环境(包括初级保健、医院、处方药和急诊)的卫生保健使用 部门(EDS))；减少财政压力(包括寄给托收的账单和灾难性的自付 费用)；并降低了抑郁症的患病率；但在以下几个指标上没有可检测到的影响 身体健康(包括血压、胆固醇和糖尿病血糖控制)。 这个项目将利用我们在俄勒冈州医疗保险实验上的工作来构建几个新的数据集 并进行新的分析，以评估医疗补助覆盖范围对健康和其他结果的多方面影响， 包括：慢性身体状况和精神健康的护理和健康结果，包括糖尿病， 哮喘和抑郁症；急诊室和医院随时间的使用模式以及不同护理地点的可替换性； 以及牙科护理和结果。我们还将开发一种新的计量经济学方法来评估和 综合保险对健康的多维影响。当政策制定者和利益相关者评估 扩大获得医疗保险的广泛后果，我们相信这些分析将增加至关重要的 医疗补助对医疗保健使用、质量和长期健康结果的许多潜在影响的证据 老龄化的人口。

PROJECT SUMMARY/ABSTRACT Project 7 – How Health Insurance Affects Health Understanding the consequences of health insurance coverage is central to evaluating proposals to expand or modify health insurance coverage in the U.S. Yet there is remarkably little convincing evidence on the impact of insuring the uninsured on their medical utilization, health outcomes, health behaviors, or overall well-being, largely because enrolling in health insurance is a choice that is made jointly with other choices that determine these outcomes. This project takes advantage of a remarkable opportunity to provide just such evidence. For a limited window in early 2008, Oregon opened a waiting list for enrollment in its public health insurance program for low income adults, and then randomly drew names from the list to determine who would be given the opportunity to enroll. This unique policy environment provided researchers with a rare occasion to bring the strengths of random assignment – the standard in medical trials – to address a critical social policy question. This proposal builds on our prior work assessing the effects of Medicaid on health care use, health, and well-being, including a focus on the near-elderly (those aged 50-64) whose health risks are in many ways similar to those aged 65 and up and who will soon age onto Medicare themselves. We found that Medicaid substantially increased health care use across settings (including primary care, hospitals, prescription drugs, and emergency departments (EDs)); reduced financial strain (including bills sent to collection and catastrophic out-of-pocket expenses); and reduced the prevalence of depression; but had no detectable effects on several measures of physical health (including blood pressure, cholesterol, and diabetic blood sugar control). This project will leverage our work on the Oregon Health Insurance Experiment to build several new data sets and conduct new analyses to assess multi-faceted effects of Medicaid coverage on health and other outcomes, including: care and health outcomes for chronic physical conditions and mental health, including diabetes, asthma, and depression; patterns of ED and hospital use over time and substitutability of different sites of care; and dental care and outcomes. We will also develop a novel econometric method for assessing and synthesizing the multidimensional effects of insurance on health. As policy-makers and stakeholders assess the broad consequences of expanded access to health insurance, we believe these analyses will add crucial evidence on the many potential effects of Medicaid on health care use, quality, and long-term health outcomes of an aging population.