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

项目总结/摘要 研究项目：即使有健康保险，许多成年人报告与成本有关的护理障碍，可能与 不断上涨的保费，成本分摊要求和其他医疗保健相关费用，如 运输在社会阶层的健康差异不断扩大，收入平等不断提高的背景下， 本研究的目的是研究旨在改变收入分配的政策变化- 最低工资-影响到人们获得医疗保健、粮食不安全和心理健康， 收入分配的低端。虽然联邦最低工资自2009年以来一直保持不变，但30年来， 此后，各州提高了最低工资。有大量的经济和社会文献 最低工资如何影响收入和就业;这些研究通常显示零到非常温和 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。然而 最低工资对获得医疗保健和健康的影响尚未得到如此详细的研究。 本提案将审查三个具体结果，这些结果可能最直接地受到增加预算的影响。 最低工资：获得保健的障碍、粮食不安全和心理痛苦。医疗保健可以减轻 低收入的一些下游健康后果，但获得医疗保健本身因 收入：2017年，最低收入群体中29%的非老年人无法看医生 因为成本，而最高收入群体的比例为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粮食不安全和精神状况不佳的阻碍。 卫生保健，这也集中在低收入家庭。该研究将使用国家 健康调查数据和准实验方法，以实现两个关键目标。首先，我会评估 最低工资法在获得医疗保健、粮食不安全和最有可能 从事低工资职业。其次，我将研究最低工资法对健康的不同影响 以及按种族、民族、慢性病状况和地理区域获得医疗保健的机会。总的来说，我试图 发现什么干预措施，以解决收入不平等的加剧可以揭示收入之间的联系， 不平等和机会。这项研究的发现将为目前关于以下问题的争论提供新的证据： 最低工资和旨在提高收入分配低端收入的相关政策。 培训计划和环境：我的具体培训目标包括获得高级定量分析技能。 政策评估和因果推理的方法;发展跨学科的专门知识， 贫困可能影响获得医疗保健和健康，包括确切的基本机制; 在调查设计和以调查为基础的获取和健康结果计量方面的专门知识。充满活力的， 哈佛大学经济与跨学科系的支持性和跨学科文化 卫生政策的主动性为我追求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.