Pathways from Health Insurance to Subjective Well-Being and Psychological Health at Older Ages

原件K01助学金项目摘要/摘要 世界卫生组织将“Health”定义为“…”一种完全的身体、精神和社会福祉的状态，而不仅仅是 没有疾病或虚弱的。“事实上，心理健康，特别是“主观幸福感”这一概念 (SWB)是社会福利的重要指标正在获得相当大的政策吸引力，经合组织和 欧盟支持利用主权财富基金来补充甚至取代传统的 国内生产总值等进步。在制定SWB措施和记录方面取得了长足的进步 它们与宏观和微观层面的变量之间的关系，对制度的影响更是知之甚少 医疗保险等因素对这些措施的影响。 我提出了一项研究议程，将促进我们对医疗保险如何影响精神健康的了解- 这里的定义不仅是没有精神疾病，而且还有老年人的主观幸福感。近期 有证据表明，影响可能相当大：最近的两个随机实验表明， 医疗保险将抑郁症筛查阳性的可能性降低了14%-30%。只有几个人 然而，对于主观幸福感和小样本容量的测量，这些实验只能提供有限的信息 健康保险影响心理健康的途径。我提议的工作将填补这一空白 知识。我将重点介绍两条途径。第一个也是最直接的途径是提高利用率 由于保险，包括药物在内的精神健康治疗的费用。另一个机制，已经收到了 注意力明显较少，与暴露在风险、压力和担忧中有关。医疗保险减少了对 灾难性的自付医疗支出风险和相关的财政压力。我以前的作品 研究发现，在受教育程度较低的人群中，医疗保险造成的医疗经济压力的减少幅度最大。 医疗保险还可能减少与获得医疗保健和整体健康相关的压力。老年人 这一压力通道对人群来说可能是最重要的：他们有更高的医疗保健率 高使用率、更大的自付支出和更高的灾难性支出风险。 K01指导研究科学家发展奖将使我能够在现有研究的基础上再接再厉 优势，并通过医疗保险扩大我在医疗保险方面的工作，将SWB和精神健康保险包括在内 健康，我以前没有接受过培训的领域。为了确保拟议工作的成功，我将得到指导 由不同的知名学者组成，他们在心理学、精神病学、卫生服务、卫生政策方面具有专业知识 经济学和行为经济学。这些研究人员将指导我制定一份详细的培训计划 其中包括指导性阅读、正式课程作业以及专业研讨会和会议。这样的研究 议程将帮助我实现我的长期职业目标，将自己确立为一名健康经济学家，专门研究 健康保险及其对个人结果的影响，包括精神健康；成功地进一步发展 以独立科学家的身份参与研究项目；并成为该领域的关键研究人员。

Original K01 Grant Project Summary/Abstract The WHO defines “health” as “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In fact, the notion that mental health and, in particular, “subjective well-being” (SWB) is an important proxy for social welfare is gaining considerable policy traction, with the OECD and the European Union supporting initiatives to use SWB to supplement or even replace traditional measures of progress such as GDP. While great strides have been made in developing measures of SWB and documenting their relationship with macro and micro-level variables, far less is understood about the impact of institutional factors, such as health insurance, on these measures. I propose a research agenda that will advance our knowledge of how health insurance impacts mental health – defined here as not only the absence of mental illness but also the presence of SWB – of the elderly. Recent evidence suggests the effects may be quite large: two recent randomized experiments have shown that gaining health insurance reduces the probability of screening positive for depression by 14-30%. With only a few measures of SWB and small sample sizes, however, these experiments can shed only limited light on the pathways through which health insurance affects mental health. My proposed work will fill in this gap in knowledge. I will focus on two pathways. The first and most straightforward pathway is an increase in utilization of mental health treatments, including medications, due to insurance. The other mechanism, which has received significantly less attention, relates to exposure to risk, stress and worry. Health insurance reduces exposure to catastrophic out-of-pocket medical expenditure risk and related financial strain substantially. My previous work finds that reductions in medical financial strain due to Medicare are largest among low-educated populations. Health insurance is also likely to reduce stress related to access to health care and to overall health. The elderly is the population for which this stress channel is probably most important: they have higher rates of healthcare utilization, larger out-of-pocket expenditures and higher risk of catastrophic spending. The K01 Mentored Research Scientist Development Award will allow me to build on my existing research strengths and to expand my work on health insurance coverage through Medicare to include SWB and mental health, areas in which I have no previous training. To ensure the success of the proposed work, I will be mentored by a diverse group of renowned scholars, with expertise in psychology, psychiatry, health services, health policy and economics, and behavioral economics. These researchers will guide me through a detailed training plan which includes guided readings, formal coursework and professional seminars and conferences. Such research agenda will help me reach my long-term career goal to establish myself as a health economist specializing in health insurance and its impact on individual outcomes, including mental health; successfully develop further research projects as an independent scientist; and become a key researcher in this field.