This chapter presents the Committee's review of studies that
address the impact of health insurance on various health-related outcomes. It
examines research on the relationship between health insurance (or lack of
insurance), use of medical care and health outcomes for specific conditions and
types of services, and with overall health status and mortality. There is a
consistent, positive relationship between health insurance coverage and
health-related outcomes across a body of studies that use a variety of data
sources and different analytic approaches. The best evidence suggests that
health insurance is associated with more appropriate use of health care
services and better health outcomes for adults.
The discussion of the research in this chapter is organized
within sections that encompass virtually all of the research literature on
health outcomes and insurance status that the Committee identified. The chapter
sections include the following:
- Primary
prevention and screening services
- Cancer
care and outcomes
- Chronic
disease management, with specific discussions of diabetes, hypertension,
end-stage renal disease (ESRD), HIV disease, and mental illness
- Hospital-based
care (emergency services, traumatic injury, cardiovascular disease)
- Overall
mortality and general measures of health status
The Committee consolidated study results within categories
that reflect both diseases and services because these frameworks helped in
summarizing the individual studies and subsumed similar research structures and
outcome measures. Older studies and those of lesser relevance or quality are
not discussed within this chapter devoted to presenting study results and
reaching Committee findings. However, all of the studies reviewed are described
briefly in Appendix B.
The studies presented in some detail in this chapter are
those that the Committee judged to be both methodologically sound and the most
informative regarding health insurance effects on health-related outcomes.1 Most
studies report a positive relationship between health insurance coverage and
measured outcomes. However, all studies with negative results that are contrary
to the Committee's findings are presented and discussed in this chapter. Appendix B includes
summaries of the complete set of studies that the Committee reviewed.
In the pages that follow, the Committee's findings introduce
each of the five major sections listed above and also some of the subsections
under chronic disease and hospital-based care. All of the Committee's specific
findings are also presented together in Box 3.12 in the concluding section of this chapter.
These findings are the basis for the Committee's overall conclusions in Chapter 4.
Specific Committee Findings. Uninsured adults are less
likely than adults with any kind of health coverage to receive preventive and
screening services and less likely to receive these services on a timely basis.
Health insurance that provides more extensive (more...)
CONCLUSION
This chapter has presented studies examining the impact of health insurance status on general measures of population health, on health care and clinical outcomes for specific conditions, and on the appropriate use of preventive services for the nonelderly adult population in the United States. This body of research yields largely consistent and significant findings about the relationship between health insurance and health-related outcomes. In summary, uninsured adults receive health care services that are less adequate and appropriate than those received by patients who have either public or private health insurance, and they have poorer clinical outcomes and poorer overall health than do adults with private health insurance.