Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
Health Serv Res. 2020 Oct;55 Suppl 2(Suppl 2):815-822. doi: 10.1111/1475-6773.13325. Epub 2020 Jul 22.
To add to the evidence base on causal linkages between health insurance coverage and health status, controlling for sociodemographic factors, by analyzing longitudinal data.
Secondary data from the Panel Study of Income Dynamics (PSID), 2009-17, 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.
2017 data on self-reported health status, work limitations, and death were analyzed as outcomes based upon the degree of exposure to health insurance in 2011-17. All variables were collected biannually for four years beginning in 2011. Having health insurance at each point in time was, in turn, modeled as a function of several sociodemographic factors.
Data were downloaded using the crosswalk tool available at the PSID website. Because individual health insurance questions were only asked of heads and spouses in households beginning in 2011, we analyzed only these records.
Among respondents who were not in fair or poor health in 2009, each additional 2 years 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.
Our results suggest that the effect of health insurance on health status may compound over time, although unevenly by race. Since people who report fair or poor health status represent the bulk of utilization and spending, our findings provide evidence in support of viewing coverage expansions as investments that will pay dividends in the form of lower utilization over time. 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.
通过分析纵向数据，在控制社会人口因素的情况下，为健康保险覆盖范围与健康状况之间的因果关系提供更多证据。
来自收入动态面板研究（PSID）的二手资料，该研究是一项始于 1968 年、涵盖广泛社会经济主题的纵向、多代研究，但直到最近才开始收集有关个人健康保险的有用信息。
2017 年基于 2011-17 年期间的健康保险暴露程度，分析了自我报告的健康状况、工作限制和死亡等结果。所有变量均在 2011 年开始的四年内每两年收集一次。在每个时间点都有健康保险，这反过来又被建模为几个社会人口因素的函数。
使用 PSID 网站上提供的交叉工具下载数据。由于个人健康保险问题仅在 2011 年开始询问家庭中的户主和配偶，因此我们仅分析这些记录。
在 2009 年没有处于一般或较差健康状况的受访者中，随后每增加 2 年的报告保险覆盖范围，会使 2017 年报告一般或较差健康状况的几率降低 10%；然而，这种影响在黑人受访者中并不存在。
我们的结果表明，健康保险对健康状况的影响可能会随着时间的推移而累积，尽管在种族方面存在差异。由于报告一般或较差健康状况的人代表了大部分的利用和支出，因此我们的研究结果为将覆盖范围扩大视为投资提供了证据，这些投资将随着时间的推移以较低的利用率的形式带来回报。需要做更多的工作来详细估计成本节约，这反过来可能会影响政策，以及了解和解决种族差异的根源。
