Mean expenditure per person by perceived health status, United States, 2017. The authors discuss that their findings support a plausible causal chain, but do not use causal language, as the secondary outcomes of the study were not based upon individuallevel data. You pay less for covered in-network health care, even before you meet your. Accessibility All individuals in our sample were alive in 2009; the overall rate of death by 2017 was 11.4 percent. A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. nutritional status), and self-reported health status. Uninsured status and out-of-pocket costs at midlife. 2000 Dec;35(5 Pt 1):911-32. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD. The health consequences of such extreme heat can be catastrophic. The data are from the Panel Study of Income Dynamics (PSID), 200917, which is a longitudinal, multigenerational study covering a wide array of socioeconomic topics that began in 1968 but has only recently begun collecting useful information on individual health insurance. HIPSM is a detailed microsimulation model of the health care system designed to estimate the cost and coverage effects of proposed health care policy options. doi: 10.1146/annurev.publhealth.28.021406.144042. 34 of the 46 studies reported the impact of health insurance on the level of out-of-pocket health expenditure. Sood et al. During this 3-year period, corresponding increases were seen in both public and private coverage among adults aged 18-64. It involves the rules and regulations set forth by lawmakers on a local, state, and national level. This strongly suggests that confounding due to health insurance eligibility due to work limitations is occurring. But many insured people still struggle to pay for health care, research finds. Expenses incurred by those in excellent or very good health in 2017 averaged $3029; by those in good health averaged $6,545; and by those in fair or poor health averaged $16,670. From May to September 2022, the heatwaves in Europe caused more than 60,000 heat-related deaths, recent research suggests. The ACA allows qualifying individuals and families to receive financial assistance to help cover the cost of premiums. Among the higher quality studies, i.e. We recognise the heterogeneity of insurance schemes implemented in LMICs and therefore do not attempt to generalise findings, but we aim to explore the pattern emerging from various studies and to extract common factors that may affect the effectiveness of health insurance, that should be the focus of future policy and research. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, Roles Depending on state policy, some applicants with work limitations might not qualify at all. https://doi.org/10.1371/journal.pone.0219731.t004. The impact of health insurance on health status suggests a promising positive effect, but more studies from different countries is required. https://doi.org/10.1371/journal.pone.0219731.t005. Certain variable translations were made. "New research method determines health impacts of heat and air quality: Even moderate temperature increases can cause more emergency hospital visits and deaths." ScienceDaily. We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. In theory, the gold standard for a programme evaluation is the randomised control trial, in which the treatment is randomly assigned to the participants. Health of previously uninsured adults after acquiring Medicare coverage, Medicare spending for previously uninsured adults. As services expanded, costs escalated. doi: 10.1016/j.heliyon.2023.e14025. Writing review & editing, Affiliations , In particular, while it may be argued that there is a selection effect in that people choose to purchaseor nothealth insurance coverage, the reality is that for most Americans, the choice is severely limited by one's education (making one eligible for the type of job that is likely to provide employer sponsored coverage) and one's income (as private market plans are not affordable for many higherincome individuals, and a very low income qualifies a person for Medicaid coverage). Lastly, we chose studies with high quality/low risk only to provide more robust results. Changes in reimbursement accompanied by the expansion of levels of care during an episode of illness caused stakeholders to carefully analyze value based . Policy Brief UCLA Cent Health Policy Res. Experts are assessing how the disaster will impact drug shortages. Disclaimer. For the purpose of this review, we included all health insurance schemes organised by government, comprising social health insurance and tax-based health insurance. Key findings In a large-scale, multiyear experiment, participants who paid for a share of their health care used fewer health services than a comparison group given free care. those that suitably controlled for selection bias reflected by moderate or low GRADE score and low risk of bias (score = 3) on QuEENS, seven studies reported a positive relationship between insurance and utilisation. However, the authors note that studies they identified in their review assessed the effect of insurance among individuals who were already sick. Moreover, the study examines three Medicaid expansion states compared with three control states and focuses on the impact within the lowincome population, which may limit generalizability to the entire US population. Investigation, Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. No, Is the Subject Area "China" applicable to this article? PLOS ONE promises fair, rigorous peer review, A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs. Similarly, in the 19711982 largescale randomized RAND Health Insurance Experiment, the poorest and sickest sample at the start of the experiment were found to have better health outcomes under the free plan for four out of the thirty conditions measured compared to their counterparts with costsharing. As a library, NLM provides access to scientific literature. AliS, Data were downloaded using the crosswalk tool available at the PSID website. Evidence for the effect of health insurance coverage was mixed for the other two outcome variables, with no significant effect found on death by 2017 nor on the chance of reporting a work limitation. Our research has five key findings: first, people with chronic diseases were more likely to experience both the outpatient and inpatient financial strain ( P < 0.01); second, public health insurance was found to reduce the outpatient financial strain; third, private health insurance was found to positively associate with inpatient financial barr. In this chart collection, we explore trends in how costs affect access to healthcare in the U.S. based on the National Health Interview Survey (NHIS) data through 2021.In the 2021 NHIS survey, 1 in 11 adults reported delaying or not getting medical care due to cost reasons. The authors report their analysis of the highest quality research over the past decade examining the effects of health insurance on health and conclude that insurance coverage increases access to c. If uninsured individuals expect to be covered in the future, they may reduce the consumption of preventive care or invest less in healthy behaviours. In this uncertain climate, they must now recalibrate to overcome suddenly exacerbated challenges like constrained capital, a low interest rate environment, manual processes, unengaged customer experience, and . A full description of the included studies is presented in the supporting information (S2 Table). The site is secure. The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies, Free for All? The .gov means its official. Please enable it to take advantage of the complete set of features! Programme evaluation has been of interest to many researchers for reporting on the effectiveness of a public policy to policymakers. Time. It was also calculated that public spending to insure individuals prior to age 65 would be offset by about half from savings due to improved health. An official website of the United States government. Epub 2022 Nov 25. Health Serv Res . Insurance companies offer a range of plans and . Financial protection, as measured by changes in out-of-pocket (OOP) health expenditure at household or individual level, and also catastrophic health expenditure or impoverishment from medical expenses. Committee on the consequences of Uninsurance which provides a good explanation for the beneficial health effects of NCMS. 10 The Impact of Health Insurance on Health Annual Review of Public Health Vol. The Oregon health insurance experiment: evidence from the first year, Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach, Mortality and access to care among adults after state Medicaid expansions. Results from the more recent 2008 randomized control trial, the Oregon Health Insurance Experiment, support these findings in that no significant effect of gaining Medicaid coverage was found on clinical outcomes or mortality in the years following the lottery. 1 19 How does health insurance affect health? More work is needed to produce detailed estimates of cost savings, which may in turn influence policy, as well as to understand and address the source of racial disparity. FOIA Brown School, [47,49] As preventive treatment is free for all, both authors attributed this increased demand to the schemes capitation system, incentivising providers to promote preventive care to avoid future costly treatments. Our results suggest that the effect of health insurance on health status may compound over time, although unevenly by race. Characteristics of PSID sample population, weighted Researchers did however find that the group assigned to health insurance coverage had better selfreported physical and mental health compared with the control group, supporting results from longitudinal studies discussed above. Conceptualization, It is difficult to draw an overall conclusion about the impact of health insurance on financial protection, most likely because of differences in health insurance programmes. PMC Of the 14 studies reporting this measure, nine reported reduction in the risk of catastrophic expenditure, three found no statistically significant difference, and two found a negative effect of health insurance. a. Known as the Health Insurance Premium Tax Credit, this subsidy helps people who need health insurance afford their coverage. However, the most straightforward goal is likely that of increased access to health insurance coverage, whether through modifications to the Affordable Care Act, additional states taking up the Medicaid expansion option, or proposals that aim for universal coverage. [5] Low- and middle-income countries (LMICs) face particular challenges in achieving UHC due to particularly limited public resources for health care, inefficient allocation, over-reliance on out-of-pocket payments, and often large population size. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0219731, https://doi.org/10.1371/journal.pone.0225237, https://doi.org/10.1596/978-1-4648-0297-3, https://doi.org/10.1080/13545701.2015.1088658, https://doi.org/10.1596/978-0-8213-8982-9, https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups, http://dx.doi.org/10.1016/j.jdeveco.2015.10.008, http://dx.doi.org/10.1186/s13561-016-0083-9, http://dx.doi.org/10.1186/s13561-016-0111-9, https://doi.org/10.1016/j.chieco.2015.02.003. The https:// ensures that you are connecting to the The bivariate relationship between continuous insurance coverage over time and later health status is demonstrated in Figure1. Social health insurance is theoretically a mandatory scheme that requires contribution from the enrolees. After reviewing the full-texts, 68 studies were included in the systematic review (see Fig 1 for the PRISMA diagram). For more information about PLOS Subject Areas, click and transmitted securely. Regardless of the specific negative health outcome considered, age was always significantly associated with negative outcomes. 8755 abstracts and 118 full-text articles were assessed. cRandomised studies were considered to have low risk of bias. The interest in achieving UHC via publicly funded health insurance is likely to increase even further in the coming years, and it is one of the United Nations Sustainable Development Goals (SDGs) for 2030[111]. an increase in out-of-pocket expenditure). It suggests that other modifiable factors, such as education and income, are important drivers as well. No, Is the Subject Area "Medical risk factors" applicable to this article? much of the available evidence is unable to directly answer this question. Careers, Unable to load your collection due to an error. Recent results from a randomized pilot study in which the IRS sent informational letters to 3.9million taxpayers who paid a tax penalty for lacking health insurance coverage under the Affordable Care Act found that the increase in coverage in the two years following reduced mortality among middleaged adults. 13 HIPSM is based on two years of the American Community Survey, which provides a representative sample of families large enough for us to produce estimates for individual states and smaller . However, one purpose in using the PSID is that it is a populationlevel dataset not focused only on Medicare or Medicaideligible populations, so its findings are more general than those of many other studies. The major purpose of buying a health plan is to ensure that you have adequate money to fund your medical treatment in the time of need, which translates to effective financial planning. Correction: The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. [108,109] Current overall evidence cannot suggest a definite conclusion considering the heterogeneity in chosen outcomes. Similarly, the most educated group was 63.5 percent as likely to die by 2017 and only 55.6 percent as likely to report a work limitation in 2017 compared with the least educated group. Barker AR, Li L. The cumulative impact of health insurance on health status. Using the TVSEP dataset waves 2013, 2016, and 2017, this paper fills a gap in the literature by investigating the impacts of health insurance on households' financial service choices. Competing interests: The authors have declared that no competing interests exist. In one study, continuously and intermittently uninsured adults ages 5060 were found to be more likely to have a major decline in overall health (defined by selfreported health status) and the development of new physical difficulties compared with their continuously insured counterparts. Orlando Health is a 3,888-bed hospital system that includes 24 open hospitals and emergency departments and five that are coming soon. We identified 12 studies, with considerable variation in the precise health measure considered (see Table 4). It was a good deal. Having health insurance at each point in time was, in turn, modeled as a function of several sociodemographic factors. Three main findings were observed: https://doi.org/10.1371/journal.pone.0219731.t002. Someone alive all 4years, with income below 100 percent FPL in 2 of the years, would have a value of 50. : Lessons from The RAND Health Insurance Experiment, The Oregon experimenteffects of Medicaid on clinical outcomes. Table 5 provides a summary of results classified by three type of insurance scheme: community-based health insurance, voluntary health insurance (non-CBHI), and compulsory health insurance. No language restrictions were applied. Writing original draft, 20 However, GRADE does not rate observational studies based on whether they controlled for selection bias. Several studies from China found the utilisation of expensive treatment and higher-level health care facilities to have increased following the introduction of the insurance scheme. Extrapolation from the Rand estimates of the impact of health insurance on health spending suggests that the overall spread of health insurance between 1950 and 1990 can explain only a very small part of the six fold rise in real per capita health spending over this period [Manning et al. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage. 9 Another study examined the effects of gaining Medicare at age 65 among people who were insured continuously prior to that time, compared with those who spent time uninsured before enrolling. The Administration's proposed rule would reduce the maximum enrollment term in short-term, limited duration (STLD) health insurance plans to three months, with an option for a one-month . Multiple comparison groups were allowed, but an uninsured group had to be one of them. [39,49,89,103] In cases where a health insurance programme does not have a positive effect on either utilisation, financial protection, and health status, it is particularly important to understand the underlying reasons. The tornado that ripped through a North Carolina Pfizer plant damaged the warehouse where finished drugs are stored. Slusky, David J. G. 2017. There will be a media availability immediately following the announcement. Methodology, There is extensive literature on the influence of health insurance systems in developed countries. 2023 Apr 19;23(1):270. doi: 10.1186/s12888-023-04727-7. 2020 Jun 18;13:595-607. doi: 10.2147/RMHP.S257381. As the health workers relied heavily on user fees for their income, the change of payment system from fee-for-services to capitation may have discouraged provision of high quality services. Supervision, Our findings suggest that when such coverage is . HHS Vulnerability Disclosure, Help Clipboard, Search History, and several other advanced features are temporarily unavailable. Besides the impact on utilisation and financial protection, this review identified a number of good quality studies measuring the impact of health insurance on health outcomes. Before First, many of the studies claiming to show a causal effect of health insurance on health do not do so convincingly because the observed correlation between insurance and good health m However, in the context of LMICs, the mandatory element is hard to enforce, and in practice the scheme adopts a voluntary enrolment. The site is secure. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. Observational studies that did not take account of selection bias were excluded. 8 Researchers found gains in health over multiple years among people who had been previously uninsured, compared with those who had always had coverage, especially for individuals with diabetes and cardiovascular disease. This study makes an important contribution towards our understanding of the impact of health insurance in LMICs, taking particular care in appraising the quality of studies. Agency for Healthcare Research and Quality This division is based on the mode of participation (compulsory vs voluntary), which may affect the presence of adverse selection and moral hazard. After screening of titles and abstracts, 118 studies were identified as potentially relevant. This is particularly important when trying to interpret some of the counterintuitive results encountered in some studies. , PLoS ONE 14(8): Because individual health insurance questions were only asked of heads and spouses in households beginning in 2011, we analyzed only these records. Reporting a work limitation in 2009 increased the chance of a work limitation in 2017 almost 12fold. With some exceptions (Hadley, 2003), considerable evidence has shown that health insurance coverage is associated with better self-reported health status and lower mortality risk (Franks et al., 1993; McWilliams et al., 2004; Hadley and Waidmann, 2006). A similar variable was constructed based upon the amount of time, in years, that an individual's annual income was above the federal poverty level (FPL). Projection expectile regression for sufficient dimension reduction. 2022 Jun 21;19(13):7574. doi: 10.3390/ijerph19137574. Bookshelf Citation: Erlangga D, Suhrcke M, Ali S, Bloor K (2019) The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. lixin9016@gmail.com PMID: 23540367 DOI: 10.1016/j.socscimed.2013.02.037 Abstract In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. National Library of Medicine Before It is unlikely that we have captured all of the interruptions of coverage that occurred, meaning that our estimate of the impact of truly continuous coverage on health is biased downward. [21] While there may be an appetite among policymakers to obtain favourable short term assessments, it is important to compare the impact over time, where feasible. 2 Inflation's impact on health premiums General inflation, including wage inflation, continues to remain elevated, putting significant cost pressure on small groups, the academy said. Go to: Abstract Objective To add to the evidence base on causal linkages between health insurance coverage and health status, controlling for sociodemographic factors, by analyzing longitudinal data. China[16] and India[17]). (2019) Of these, 53 percent were females, while 82 percent were white, 13 percent were black, and 5 percent identified as another race. Many individuals have also avoided routine health checkups and elective procedures during . About 81.7 percent of those reporting excellent or very good health in 2017 had been insured in all four prior survey years, compared with 70.2 percent of those reporting fair or poor health in 2017. Like other authors, we therefore describe our work as providing additional evidence of a plausible causal chain.. The .gov means its official. Wherry LR, Miller S, Kaestner R, Meyer BD. . Non-randomised studies that account for selection on both observables and unobservables, such as regression with difference-in-differences (DiD) or Heckman sample selection models, were considered to have medium risk of biassome of these studies were graded as high or low risk depending on sufficiency of assumption checks and comparison with results from other methods. ErlanggaD, Heliyon. Yes Institute of Medicine and National Research Council We noted some papers combining two common methods, such as difference-in-difference with propensity score matching (N = 10) and fixed effects with instrumental variables (N = 8), in order to obtain more robust results. The scale of the pandemic has had a significant impact on the health insurance sector. No, Is the Subject Area "Database searching" applicable to this article? Among respondents who were not in fair or poor health in 2009, each additional 2years of subsequent reported insurance coverage reduced the chance of reporting fair or poor health in 2017 by 10 percent; however, this effect was not present for black respondents. NHIS data on health insurance coverage for adults aged 18-64 from 1997 through the first 6 months of 2016 show: The percentage of uninsured decreased from 20.4% in 2013 to 12.4% in the first 6 months of 2016. government site. The cost of covering the drugs is the biggest issue. Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. All types of health services were considered in this review. [5] As a result, access to health care and the burden of financial cost in LMICs tends to be worse for the poor, often resulting in forgone care.
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