Department of Sociology, Umeå University, Sweden.
Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit (GAME), Skåne University Hospital Malmö, Lund University, Sweden.
Soc Sci Med. 2017 Oct;190:48-56. doi: 10.1016/j.socscimed.2017.08.012. Epub 2017 Aug 18.
Previous research shows that generalized trust, the belief that most people can be trusted, is conducive to people's health. However, only recently have longitudinal studies suggested an additional reciprocal pathway from health back to trust. Drawing on a diverse body of literature that shows how egalitarian social policy contributes to the promotion of generalized trust, we hypothesize that this other 'reverse' pathway could be sensitive to health insurance context. Drawing on nationally representative US panel data from the General Social Survey, we examine whether the Affordable Care Act of 2010 could have had influence on the deteriorating impact of worsening self-rated health (SRH) on generalized trust. Firstly, using two-wave panel data (2008-2010, N = 1403) and employing random effects regression models, we show that a lack of health insurance coverage negatively determines generalized trust in the United States. However, this association is attenuated when additionally controlling for (perceived) income inequality. Secondly, utilizing data from two separate three-wave panel studies from the US General Social Survey (2006-10; N = 1652; 2010-2014; N = 1187), we employ fixed-effects linear regression analyses to control for unobserved heterogeneity from time-invariant factors. We demonstrate that worsening SRH was a stronger predictor for a decrease in generalized trust prior (2006-2010) to the implementation of the Affordable Care Act. Further, the negative effect of fair/poor SRH seen in the 2006-2010 data becomes attenuated in the 2010-2014 panel data. We thus find evidence for a substantial weakening of the previously established negative impact of decreasing SRH on generalized trust, coinciding with the most significant US healthcare reforms in decades. Social policy and healthcare policy implications are discussed.
先前的研究表明，普遍信任，即大多数人可以被信任的信念，有利于人们的健康。然而，直到最近，纵向研究才表明，健康与信任之间存在着一种额外的互惠关系。借鉴大量文献表明平等主义社会政策如何促进普遍信任的发展，我们假设这种“反向”关系可能对健康保险的背景较为敏感。利用美国全国代表性的综合社会调查（General Social Survey）的面板数据，我们检验了 2010 年平价医疗法案（Affordable Care Act）是否会对自我报告健康状况恶化（self-rated health，SRH）对普遍信任的负面影响产生影响。首先，我们使用两波面板数据（2008-2010 年，N=1403）和随机效应回归模型，表明缺乏医疗保险覆盖会对美国的普遍信任产生负面影响。然而，当同时控制（感知）收入不平等时，这种关联会减弱。其次，我们利用来自美国综合社会调查（General Social Survey）的两个独立的三波面板研究的数据（2006-10 年；N=1652；2010-2014 年；N=1187），使用固定效应线性回归分析来控制时间不变因素的未观测异质性。我们表明，在平价医疗法案实施之前（2006-2010 年），SRH 恶化是普遍信任下降的更强预测因素。此外，在 2010-2014 年的面板数据中，公平/差的 SRH 的负面影响变得减弱。因此，我们有证据表明，与几十年来美国最重要的医疗保健改革相一致，SRH 下降对普遍信任的负面影响已显著减弱。我们讨论了社会政策和医疗保健政策的影响。
