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

 描述（由申请人提供）：世界卫生组织将“健康”定义为“……身体、精神和社会的完全健康状态，而不仅仅是没有疾病或虚弱。事实上，心理健康，特别是“主观幸福感”（SWB）是社会福利的重要代表的概念正在获得相当大的政策牵引力，经合组织和欧盟支持使用SWB来补充甚至取代GDP等传统进步措施的倡议。虽然已经取得了很大的进步，在制定措施的主观幸福感，并记录其与宏观和微观层面的变量的关系，远没有了解的影响，制度因素，如健康保险，对这些措施。我提出了一个研究议程，将推进我们的知识如何健康保险影响心理健康-这里定义为不仅没有精神疾病，但也存在的主观幸福感-的老年人。最近的证据表明，影响可能相当大：最近的两个随机实验表明，获得健康保险将抑郁症筛查阳性的概率降低了14- 30%。然而，由于只有少数SWB指标和小样本量，这些实验只能有限地揭示健康保险影响心理健康的途径。我提议的工作将填补这一知识空白。我将重点介绍两种途径。第一个也是最直接的途径是由于保险而增加了对心理健康治疗的利用，包括药物治疗。另一种机制受到的关注要少得多，它与风险、压力和担忧有关。健康保险大大降低了灾难性自付医疗支出风险和相关的财务压力。我之前的研究发现， 在医疗方面，受教育程度低人口因医疗保险而承受的财政压力最大。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。老年人是这种压力渠道可能最重要的人群：他们的医疗保健利用率更高，自付支出更大，灾难性支出的风险更高。K 01指导研究科学家发展奖将使我能够建立在我现有的研究优势，并通过医疗保险扩大我在医疗保险覆盖面的工作，包括SWB和心理健康，在这方面我没有以前的培训。为了确保拟议的工作取得成功，我将由一群不同的知名学者指导，他们在心理学，精神病学，卫生服务，卫生政策和经济学以及行为经济学方面具有专业知识。这些研究人员将指导我完成详细的培训计划，其中包括指导阅读，正式课程和专业研讨会和会议。这样的研究议程将帮助我实现我的长期职业目标，建立自己作为一个健康经济学家，专门研究健康保险及其对个人结果的影响，包括心理健康;成功地开发进一步的研究项目作为一个独立的科学家;并成为这一领域的关键研究人员。

 DESCRIPTION (provided by applicant): 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.