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

原始K 01资助项目摘要/摘要 世界卫生组织将“健康”定义为“.. 没有疾病或虚弱。”事实上，心理健康，特别是“主观幸福感”， (SWB)是社会福利的一个重要指标，正在获得相当大的政策牵引力，经合组织和 欧洲联盟支持利用主观幸福感来补充甚至取代传统的 比如GDP。虽然在发展主观幸福感测量和记录方面取得了很大进展， 他们与宏观和微观层面变量的关系，远没有了解的影响，制度 健康保险等因素对这些措施的影响。 我提出了一个研究议程，这将促进我们对健康保险如何影响心理健康的认识- 这里的定义不仅是指没有精神疾病，而且还存在主观幸福感-老年人。最近 有证据表明，这种影响可能相当大：最近的两项随机实验表明， 健康保险将抑郁症筛查阳性的概率降低了14- 30%。只有几 然而，由于SWB和小样本量的测量，这些实验只能对 健康保险影响心理健康的途径。我的建议工作将填补这一空白， 知识我将重点介绍两种途径。第一个也是最直接的途径是提高利用率 精神健康治疗，包括药物，由于保险。另一个机制， 注意力明显减少，与暴露于风险，压力和担忧有关。健康保险减少了风险暴露， 灾难性的自付医疗费用风险和相关的财务压力。My previous work 研究发现，由于医疗保险而导致的医疗财务压力的减少在受教育程度低的人群中最大。 健康保险也可能减少与获得医疗保健和整体健康有关的压力。老年人 是这个压力渠道可能最重要的人群：他们有更高的医疗保健率 利用率，更大的自付支出和更高的灾难性支出风险。 K 01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 我的优势，并扩大我的工作，通过医疗保险的健康保险覆盖面，包括主观幸福感和精神 健康，我以前没有受过训练的领域。为了确保所提议的工作取得成功，我将接受指导 由一群在心理学、精神病学、卫生服务、卫生政策方面具有专长的知名学者组成的 经济学和行为经济学。这些研究人员将指导我完成一个详细的训练计划 其中包括指导阅读，正式课程和专业研讨会和会议。这种研究 议程将帮助我实现我的长期职业目标，建立自己作为一个健康经济学家，专门从事 健康保险及其对个人结果的影响，包括心理健康;成功地进一步发展 研究项目作为一个独立的科学家，并成为该领域的主要研究人员。

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.