We missed this when it first came out, but two Northwestern professors and two other researchers recently released a paper on health insurance (h/t @AndrewCQuinn); it affirms that, of course, people with insurance use health care more than people without insurance, but, surprisingly, they aren’t significantly healthier:
Being uninsured significantly reduces healthcare utilization, across a number of measures. The uninsured visit the doctor and are admitted to a hospital less often, are less likely to have prescription drugs prescribed, and are more likely not to take prescribed drugs for financial reasons. However, we find little evidence of an impact of health insurance on health or mortality. Controlling for initial health and other covariates, the uninsured do not become less healthy than the insured over time, across an array of measures, including self-reported health status, heart disease, stroke, cancer, diabetes, lung disease, depression, and limits on daily activities. In our central estimates (uninsured versus all insured), we find no evidence that uninsurance predicts higher mortality for the uninsured through 12-14 years after initial observation and only mild evidence after 16-18 years.
This study echoes another done earlier this year on the Oregon Medicaid population. That study found that a randomly assigned group of people who were given access to Medicaid in Oregon used more health care services than those remaining uninsured, but without any large improvements in their physical health. (Mental health is another issue—the insurance was associated with a drop in depression). Taken together these two studies suggest that insurance can have an inflationary effect on medical spending without producing proportionately better health outcomes.That doesn’t mean that we should give up on the goal of expanding access to at least some basic forms of insurance to the whole population. There are lots of good reasons for doing that, not the least of which is preventing people who get seriously sick or injured from going bankrupt. But it does point out the costs of the way we currently fund health care. Health insurance is not health care; it’s one way of paying for health care, and it incentivizes people to use more services than they actually need. The fact has to be in the forefront even as we work to expand access.Still, as we keep a close eye on how insurance mechanisms affect our system, the most important thing to get right in the coming years is not who pays or how, but rather how people receive care. If we can improve delivery options, questions of how to expand access will become easier to answer.