Lifetime Consequences of Early-Life and Midlife Access to Health Insurance: A Review

According to this comprehensive literature review some specific groups benefit more than others from access to health insurance. In particular, health insurance does have important and broad positive effects for low-income children and vulnerable adults.

Etienne Gaudette and his colleagues Gwyn Pauley and Julie Zissimopoulos reviewed and synthesized over 100 studies that examined the effects of health insurance on individuals in early and mid-life (i.e., at ages most relevant to current debates about health care reform). Studies included in the review met the standard for a rigorous study design that measured the causal impact of insurance: randomized experiments, regression discontinuity design, instrumental variables analysis, or difference-in-difference experiments. They evaluated outcomes across economic, financial, health, and medical predictors which they organized into 14 broad economic and health categories.

The studies the researchers reviewed examined impacts across seven types of economic outcomes: labor force participation, earnings, wages, government program participation, education, savings and asset accumulations, household finances, and delayed care due to costs.  Highlights across the studies include:

  • Access to health insurance affected the labor supply of vulnerable groups including single mothers, pregnant women, and sick adults. In particular, health insurance has been shown to increase labor force participation of single mothers while decreasing participation for pregnant women. Studies of subsets of less healthy adults found that these individuals were responsive to health insurance.
  • Health insurance has been linked to improved education outcomes.
  • Insured individuals were less likely to delay care due to costs.

Health measurements linked to health insurance coverage identified in the studies included indicators on mortality, self-reported health status, prevalence of risk factors, health limitations and functional status, preventable hospitalizations, incidence/prevalence and outcomes of chronic conditions, and mental health diagnosis and outcomes. Trends the researchers found included:

  • The health of low-income children from public insurance coverage benefited in terms of reductions in ambulatory care-sensitive hospitalizations, improved indicators of overall health, and lower incidence of some chronic conditions.
  • Adults from lower socioeconomic status and adults in poor health showed health benefits from insurance coverage in terms of improved mortality, functional status, and blood pressure management.
  • Insurance was linked to improved mental health status for low-income adult population affected by health insurance reforms.

This review highlights the heterogeneous effects of health insurance coverage: though coverage has been shown to impact specific populations, benefits from insurance coverage were largely mixed or not found when assessing the general adult population.

Gaudette and his colleagues point to a number of areas that would benefit from additional research including the relationship between health insurance and government program participation, particularly the long-term effects of insurance on government program take-up later in life. In addition, the authors noted that much of the literature compared being insured to being uninsured, and did not take into account the type of insurance included in the study. Given the increased uptake of high deductible health insurance plans, more research is needed about the importance of health insurance design and quality on outcomes.

The full article is available at Medical Care Research and Review.

Citation: Gaudette, É., Pauley, G. C., & Zissimopoulos, J. M. (2017). Lifetime Consequences of Early-Life and Midlife Access to Health Insurance: A Review. Medical Care Research and Review, 1077558717740444.