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

描述(由申请人提供)：了解健康保险覆盖范围的后果对于评估在美国扩大或修改健康保险覆盖范围的提案至关重要。然而，关于为未投保者投保对他们的医疗利用、健康结果、健康行为或整体福祉的影响，几乎没有令人信服的证据，这主要是因为参加健康保险是与决定这些结果的其他选择一起做出的选择。提供此类证据的绝佳机会已经出现。2008年初，在一个有限的窗口内，俄勒冈州为某些低收入成年人开放了一份之前关闭的公共医疗保险计划的等待登记名单，然后从名单中随机抽取名字，以确定谁将有机会登记。这种独特的政策环境为研究人员提供了一个难得的机会，让他们利用随机分配的优势--医学试验的标准--来解决一个关键的社会政策问题。我们已经开始调查那些被选中和未被选中的人，并提议利用NIA的资金来极大地扩大我们数据收集和分析的范围，包括对近老年人(那些50岁-的人)进行过度抽样，他们的健康风险在许多方面与65岁及以上的人相似，他们自己很快就会进入联邦医疗保险。我们建议利用这一非同寻常和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？我们将通过三个数据来源来回答这些问题：半年一次的邮件调查，包括健康生理标记物测量在内的面对面数据收集工作，以及医院和急诊科使用的行政记录。 公共健康相关性：了解医疗保险覆盖范围的后果对于评估美国扩大或修改医疗保险覆盖范围的建议至关重要。这项拟议的研究将利用俄勒冈州正在进行的一项独特的政策实验，评估医疗保险对医疗保健利用率和健康结果的因果影响。

DESCRIPTION (provided by applicant): 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. 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 is the effect 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 health insurance coverage 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 policy experiment underway in Oregon to evaluate the causal effects of health insurance on health care utilization and health outcomes.