What Does Health Insurance Do? Evidence from the Oregon Health Insurance Lottery

其他项目信息-项目概要/摘要 了解健康保险覆盖范围的后果是评估扩大或 修改美国的医疗保险覆盖范围，但几乎没有令人信服的证据表明其影响 为未投保者的医疗利用、健康结果、健康行为或整体福祉提供保险， 很大程度上是因为参加医疗保险是一个与其他决定性选择共同做出的选择， 这些结果。这个项目利用了一个非凡的机会来提供这样的证据。用于 2008年初，俄勒冈州开放了一个有限的窗口，等待加入其公共健康保险计划 低收入成年人，然后随机抽取名单中的名字，以确定谁将获得 有机会报名。这种独特的政策环境为研究人员提供了一个难得的机会， 随机分配的优势-医学试验的标准-解决一个关键的社会政策问题。 这项提案建立在我们先前评估医疗补助对医疗保健使用、健康和健康的影响的基础上。 包括关注近老年人（50-64岁），他们的健康风险在许多方面类似于 那些65岁以上的人，他们很快就会进入医疗保险。我们发现医疗补助 增加跨环境的医疗保健使用（包括初级保健、医院、处方药和 紧急部门（ED））;减少财务压力（包括账单发送收集和灾难性的， 自付费用）;并降低抑郁症的患病率;但对几个人没有可检测的影响。 身体健康指标（包括血压、胆固醇和糖尿病血糖控制）。这 一个延续项目将利用我们在“俄勒冈州健康保险实验”或OHIE上的工作， 几个新的数据集，并进行新的分析，以评估医疗补助覆盖的多方面影响， 健康和其他结果，包括：医院和艾德使用随时间的演变; 不同的护理地点;慢性身体疾病和精神健康，包括糖尿病的护理模式， 哮喘和抑郁症;牙科保健;对人口卫生保健使用和健康结果的溢出效应。作为政策- 我们认为，决策者和利益相关者评估了扩大医疗保险覆盖范围的广泛后果， 这些分析将为医疗补助计划对项目使用、医疗保健、 质量和长期健康。

OTHER PROJECT INFORMATION – Project Summary/Abstract Understanding the consequences of health insurance coverage is central to evaluating proposals to expand or modify health insurance coverage in the U.S. Yet there is remarkably little convincing evidence on the impact of insuring the uninsured on their medical utilization, health outcomes, health behaviors, or overall well-being, largely because enrolling in health insurance is a choice that is made jointly with other choices that determine these outcomes. This project takes advantage of a remarkable opportunity to provide just such evidence. For a limited window in early 2008, Oregon opened a waiting list for enrollment in its public health insurance program for 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 provided researchers with a rare occasion to bring the strengths of random assignment – the standard in medical trials – to address a critical social policy question. This proposal builds on our prior work assessing the effects of Medicaid on health care use, health, and well- being, including a focus on 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 found that Medicaid substantially increased health care use across settings (including primary care, hospitals, prescription drugs, and Emergency Departments (EDs)); reduced financial strain (including bills sent to collection and catastrophic out- of-pocket expenses); and reduced the prevalence of depression; but had no detectable effects on several measures of physical health (including blood pressure, cholesterol, and diabetic blood sugar control). This continuation project will leverage our work on the “Oregon Health Insurance Experiment” or OHIE to build several new data sets and conduct new analyses to assess multifaceted effects of Medicaid coverage on health and other outcomes, including: the evolution of hospital and ED use over time; the substitutability of different sites of care; patterns of care for chronic physical conditions and mental health, including diabetes, asthma, and depression; dental care; spillovers to population health care use and health outcomes. As policy- makers and stakeholders assess the broad consequences of expanded access to health insurance, we believe these analyses will add crucial evidence on the many potential effects of Medicaid on program use, health care quality, and long-term health.