The causal effect of health insurance on utilization and outcomes in adults: A systematic review of us studies

Joseph D. Freeman, Srikanth Kadiyala, Janice F Bell, Diane P. Martin

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

BACKGROUND: No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes. OBJECTIVE: To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States. RESEARCH DESIGN: A systematic search of 3 electronic databases (PubMed, JSTOR, EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design). RESULTS: A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review-4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies. CONCLUSIONS: Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.

Original languageEnglish (US)
Pages (from-to)1023-1032
Number of pages10
JournalMedical Care
Volume46
Issue number10
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Health Insurance
Patient Acceptance of Health Care
Health
Longitudinal Studies
Cohort Studies
Cohort Effect
PubMed
Causality
Health Status
Publications
Research Design
Regression Analysis
Databases
Physicians
Control Groups
Mortality
Wounds and Injuries
Population

Keywords

  • Causation
  • Health insurance
  • Outcomes
  • Uninsured
  • Utilization

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The causal effect of health insurance on utilization and outcomes in adults : A systematic review of us studies. / Freeman, Joseph D.; Kadiyala, Srikanth; Bell, Janice F; Martin, Diane P.

In: Medical Care, Vol. 46, No. 10, 10.2008, p. 1023-1032.

Research output: Contribution to journalArticle

Freeman, Joseph D. ; Kadiyala, Srikanth ; Bell, Janice F ; Martin, Diane P. / The causal effect of health insurance on utilization and outcomes in adults : A systematic review of us studies. In: Medical Care. 2008 ; Vol. 46, No. 10. pp. 1023-1032.
@article{56ed8107824046ef87680196a0b1c1a1,
title = "The causal effect of health insurance on utilization and outcomes in adults: A systematic review of us studies",
abstract = "BACKGROUND: No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes. OBJECTIVE: To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States. RESEARCH DESIGN: A systematic search of 3 electronic databases (PubMed, JSTOR, EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design). RESULTS: A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review-4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies. CONCLUSIONS: Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.",
keywords = "Causation, Health insurance, Outcomes, Uninsured, Utilization",
author = "Freeman, {Joseph D.} and Srikanth Kadiyala and Bell, {Janice F} and Martin, {Diane P.}",
year = "2008",
month = "10",
doi = "10.1097/MLR.0b013e318185c913",
language = "English (US)",
volume = "46",
pages = "1023--1032",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - The causal effect of health insurance on utilization and outcomes in adults

T2 - A systematic review of us studies

AU - Freeman, Joseph D.

AU - Kadiyala, Srikanth

AU - Bell, Janice F

AU - Martin, Diane P.

PY - 2008/10

Y1 - 2008/10

N2 - BACKGROUND: No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes. OBJECTIVE: To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States. RESEARCH DESIGN: A systematic search of 3 electronic databases (PubMed, JSTOR, EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design). RESULTS: A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review-4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies. CONCLUSIONS: Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.

AB - BACKGROUND: No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes. OBJECTIVE: To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States. RESEARCH DESIGN: A systematic search of 3 electronic databases (PubMed, JSTOR, EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design). RESULTS: A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review-4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies. CONCLUSIONS: Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.

KW - Causation

KW - Health insurance

KW - Outcomes

KW - Uninsured

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=53449089336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=53449089336&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e318185c913

DO - 10.1097/MLR.0b013e318185c913

M3 - Article

C2 - 18815523

AN - SCOPUS:53449089336

VL - 46

SP - 1023

EP - 1032

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 10

ER -