Understanding the effect of increases in the minimum wage on access to health care and health

项目摘要/摘要 研究项目：即使有医疗保险，许多成年人也报告了与费用相关的护理障碍，可能与 到不断上涨的保费、成本分担要求和其他与医疗保健相关的费用，如 交通。在按社会阶层划分的健康差异不断扩大的背景下，收入不平等日益加剧， 这项研究的目标是检查旨在改变收入分配的政策的变化- 最低工资--影响人们获得医疗保健、食品不安全和心理健康的机会 收入分配的低端。虽然联邦最低工资自2009年以来保持不变，但有30 自那以后，各州都提高了最低工资。有一个强劲的经济和社会文献看起来 最低工资对收入和就业的影响；这些研究通常显示为零到非常有限 对就业的影响和对收入的积极影响，包括缩小种族收入差距。还没有 最低工资对获得保健和保健的影响尚未得到详细研究。 这项提案将审查三个可能受到最直接影响的具体结果 最低工资：医疗保健障碍、食品不安全和心理困扰。医疗保健可以缓解 低收入带来的一些下游健康后果，但获得医疗保健的机会本身因情况而异 收入：2017年，最低收入群体中29%的非老年成年人看不到医生 由于成本的原因，最高收入群体的这一比例为9%。即使对于那些能够获得医疗保健的人来说， 遵循治疗计划和管理慢性病可能会受到食物不安全和精神不佳的阻碍 健康，这也集中在低收入家庭中。拟议的研究将使用国家 健康调查数据和准实验方法实现两个关键目标。首先，我会评估一下效果 最低工资法关于最有可能获得医疗保健、食品不安全和心理健康的成年人 从事低薪工作。第二，我将研究最低工资法律对健康的不同影响 以及按种族、民族、慢性病状况和地理位置获得医疗保健的机会。概括地说，我寻求 了解应对日益加剧的收入不平等的干预措施可以揭示收入与收入之间的联系 不平等和可及性。这项研究的发现将为目前关于 寻求在收入分配的较低端提高收入的最低工资和相关政策。 培训计划和环境：我的具体培训目标包括获得高级量化技能 政策评估和因果推断的方法；在如何获得收入方面发展跨学科的专门知识 贫穷可影响获得保健和保健，包括精确的基本机制； 在调查设计和基于调查的获取和健康结果衡量方面的专业知识。充满活力的， 哈佛大学经济系和教职员工间的支持性和跨学科文化 健康政策倡议为实现我的培训目标和研究项目提供了理想的环境。

Project Summary/Abstract Research Project: Even with health insurance, many adults report cost-related barriers to care, possibly related to rising premiums, cost-sharing requirements, and other health care-associated expenses such as transportation. In the context of widening differences in health by social class alongside rising income equality, the goal of this research is to examine how changes in a policy intended to change the distribution of income – the minimum wage – affects access to health care, food insecurity, and mental health among people at the lower end of the income distribution. While the federal minimum wage remained unchanged since 2009, thirty states have increased their minimum wage since then. There is a robust economic and social literature looking at how the minimum wage affects earnings and employment; these studies generally show null to very modest effects on employment and positive effects on earnings, including a reduction in the racial earnings gap. Yet the impact of the minimum wage on access to health care and health has not been studied in as much detail. This proposal will examine three specific outcomes that could be affected most directly by increases in the minimum wage: barriers to health care, food insecurity, and psychological distress. Health care could mitigate some of the downstream health consequences of low income, but access to health care itself varies by income: in 2017, 29% of non-elderly adults in the lowest income group were unable to see a physician because of cost, versus 9% in the highest income group. Even for those able to access health care, the ability to follow a treatment plan and manage chronic illness can be hindered by food insecurity and poor mental health, which are also concentrated among low-income households. The proposed study will use national health survey data and quasi-experimental methods to accomplish two key aims. First, I will assess the effect of minimum wage laws on access to health care, food insecurity, and mental health among adults most likely to work in low-wage occupations. Second, I will examine the differential impact of minimum wage laws on health and access to health care by race, ethnicity, chronic disease status, and geography. Broadly, I seek to discover what interventions to address rising income inequality can reveal about the link between income inequality and access. The findings from this research will add novel evidence to current debates about minimum wage and related policies that seek to raise earnings at the lower end of the income distribution. Training Plan and Environment: My specific training goals include acquiring skills in advanced quantitative methods for policy evaluation and causal inference; developing an interdisciplinary expertise in how income and poverty can affect access to health care and health, including precise underlying mechanisms; and gaining expertise in survey design and survey-based measurement of both access and health outcomes. The vibrant, supportive, and interdisciplinary culture at Harvard University’s Department of Economics and Interfaculty Initiative in Health Policy provide an ideal environment for pursuing my training goals and research project.