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The Effect of Health Insurance on Utilization and Outcomes: The Oregon Lottery

健康保险对利用和结果的影响：俄勒冈州彩票

基本信息

批准号：
7854625
负责人：
Katherine Baicker
金额：
$ 577.33万
依托单位：
NATIONAL BUREAU OF ECONOMIC RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7854625
关键词：
Accident and Emergency department Address Adult Affect Age Area Asses Caring Chronic Communities Data Data Collection Data Sources Diabetes Mellitus Drug Prescriptions Elderly Emergency Care Enrollment Environment Evaluation Funding Funding Opportunities Gold Health Health Insurance Health Policy Health behavior Hospitals Instruction Insurance Insurance Coverage Interview Investments Life Low income Mails Measurement Measures Medical Medicare Minority Names Operative Surgical Procedures Oregon Outcome Patient Self-Report Pattern Personal Satisfaction Persons Physicians Physiological Play Policies Population Preventive Primary Health Care Psyche structure Public Health Randomized Records Research Research Infrastructure Research Personnel Resources Risk Role Running Sample Size Sampling Science Services Social Policies Surveys Uninsured Waiting Lists aged blood pressure regulation comparison group control trial cost health care service utilization improved interest physical conditioning programs public health relevance satisfaction

项目摘要

DESCRIPTION (provided by applicant): The Effect of Health Insurance on Utilization and Outcomes: The Oregon Lottery. Understanding the consequences of health insurance coverage is central to evaluating proposals to expand or modify health insurance coverage in the U.S. It also has important long-run fiscal implications for Medicare. Yet there is remarkably little convincing evidence on the effect of insuring the uninsured on health care utilization, health outcomes, and overall well-being, because it is difficult to disentangle the effects of health insurance from other factors that differ between the insured and uninsured that also affect health. A remarkable opportunity has presented itself for providing just such evidence. For a limited window in early 2008, Oregon opened a waiting list for enrollment in its previously closed public health insurance program for certain 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 provides researchers with a rare occasion to bring the strengths of random assignment - the standard in medical trials - to address a critical social policy question. We have already begun surveying those selected and not selected in the lottery, and propose to use NIA funding to greatly extend the reach of our data collection and analysis, including over-sampling of 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 propose to capitalize on this extraordinary and unique opportunity to address questions in three different areas: First, how does insurance affect health care utilization? Second, what are the effects of insurance on health? Third, how do the effects of health insurance differ for different groups? We will answer these questions by drawing on three data sources: semi-annual mail surveys, an in-person data collection effort including measurement of physiological markers of health, and administrative records on hospital and emergency department use. PUBLIC HEALTH RELEVANCE: Understanding the consequences of gaining access to health insurance is central to evaluating proposals to expand or modify health insurance coverage in the U.S. The proposed research will take advantage of a unique health insurance lottery currently underway in Oregon to evaluate the causal effects of insurance on health care utilization and health outcomes. The project will powerfully leverage existing resources to allow us to explore the effects of insurance expansions for those groups of particular policy importance.

描述（由申请人提供）：健康保险对使用和结果的影响：俄勒冈州彩票。了解健康保险覆盖范围的后果对于评估扩大或修改美国健康保险覆盖范围的建议至关重要，它对医疗保险也有重要的长期财政影响。然而，几乎没有令人信服的证据表明，为未参保者提供保险对医疗保健利用、健康结果和整体福祉的影响，因为很难将健康保险的影响与参保者和未参保者之间存在差异的其他因素区分开来，这些因素也影响健康。提供这类证据的绝佳机会已经出现。在2008年初的一个有限的窗口期，俄勒冈州为某些低收入成年人开放了一个等候名单，让他们参加之前关闭的公共医疗保险计划，然后从名单中随机抽取名字，决定谁将有机会参加。这种独特的政策环境为研究人员提供了难得的机会，利用随机分配的优势——医学试验中的标准——来解决一个关键的社会政策问题。我们已经开始调查那些在抽签中被选中和没有被选中的人，并建议使用NIA的资金来大大扩大我们的数据收集和分析的范围，包括对接近老年人（50-64岁）的过度抽样，这些人的健康风险在许多方面与65岁及以上的人相似，他们很快就会进入医疗保险。我们建议利用这一非凡而独特的机会来解决三个不同领域的问题：第一，保险如何影响医疗保健的利用？第二，保险对健康有什么影响？第三，医疗保险对不同群体的影响有何不同？我们将利用三个数据来源来回答这些问题：半年一次的邮件调查，包括测量健康生理指标在内的亲自数据收集工作，以及医院和急诊科使用的行政记录。