Insurance and Health Care Expenditures: What's the Real Question?
Authors: Giancarlo DiMassa, José J. Escarce
Journal: Annals of Internal Medicine (2007)

Editorials5 June 2007Insurance and Health Care Expenditures: What's the Real Question?Giancarlo DiMassa, MD and José J. Escarce, MD, PhDGiancarlo DiMassa, MDFrom the Department of Veterans Affairs and University of California, Los Angeles, Robert Wood Johnson Clinical Scholars Program and David Geffen School of Medicine at University of California, Los Angeles; Los Angeles, CA 90095.Search for more papers by this author and José J. Escarce, MD, PhDFrom the Department of Veterans Affairs and University of California, Los Angeles, Robert Wood Johnson Clinical Scholars Program and David Geffen School of Medicine at University of California, Los Angeles; Los Angeles, CA 90095.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-11-200706050-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For more than a quarter century, researchers and policymakers have known that people who must pay out of pocket for health care—because they are uninsured or face high levels of cost sharing—use less care (1, 2). However, uninsured persons differ from insured persons in a variety of measured and unmeasured ways (3). Consequently, the precise effect of insurance on health care utilization and expenditures is difficult to quantify by using observational data.In this issue, Ward and Franks (4) take a new approach to addressing this question. They used data from the Medical Expenditure Panel Survey, which collects information on ...References1. Brook RH, Ware JE, Rogers WH, Keeler EB, Davies AR, Donald CA, et al. Does free care improve adults' health? Results from a randomized, controlled trial. N Engl J Med. 1983;309:1426-34. [PMID: 6355851] CrossrefMedlineGoogle Scholar2. Newhouse JP, Manning WG, Morris CN, Orr LL, Duan N, Keeler EB, et al. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981;305:1501-7. [PMID: 6795505] CrossrefMedlineGoogle Scholar3. Committee on the Consequences of Uninsurance. Board of Health Care Services. Institute of Medicine. Care Without Coverage: Too Little, Too Late. Washington, DC: Institute of Medicine; 2002:xvi. Google Scholar4. Ward L, Franks P. Changes in health care expenditure associated with gaining or losing health insurance. Ann Intern Med. 2007;146:768-74. LinkGoogle Scholar5. Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987;77:251-77. [PMID: 10284091] MedlineGoogle Scholar6. Levy H, Meltzer D. What do we really know about whether health insurance affects health?. In: McLaughlin CG, eds. Health Policy and the Uninsured. Washington, DC: Urban Institute Pr; 2004:179-204. Google Scholar7. Lurie N, Ward NB, Shapiro MF, Brook RH. Termination from Medi-Cal—does it affect health? N Engl J Med. 1984;311:480-4. [PMID: 6379458] CrossrefMedlineGoogle Scholar8. Lichtenberg F. The effects of Medicare health on health care utilization and outcomes.. In: Garber AM, eds. Frontiers in Health Policy Research. 5 Cambridge, MA: MIT Pr; 2002. Google Scholar9. Currie J, Gruber J. Health insurance eligibility, utilization of medical care and child health. Q J Econ. 1996;111:431-66. CrossrefGoogle Scholar10. Currie J, Gruber J. Saving babies: the efficacy and cost of recent changes in the medicaid eligibility of pregnant women. J Polit Econ. 1996;104:1263-96. CrossrefGoogle Scholar11. Currie J, Gruber J. The technology of birth: health insurance, medical interventions, and infant health. NBER Working Paper no. 5985. Cambridge, MA: National Bureau of Economic Research; 1997. Google Scholar12. Haas JS, Udvarhelyi S, Epstein AM. The effect of health coverage for uninsured pregnant women on maternal health and the use of cesarean section. JAMA. 1993;270:61-4. [PMID: 8510298] CrossrefMedlineGoogle Scholar13. Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. J Am Stat Assoc. 1996;91:444-55. CrossrefGoogle Scholar14. Harris KM, Remler DK. Who is the marginal patient? Understanding instrumental variables estimates of treatment effects. Health Serv Res. 1998;33:1337-60. [PMID: 9865223] MedlineGoogle Scholar15. Goldman DP, Bhattacharya J, McCaffrey DF, Duan N, Leibowitz AA, Joyce GF, et al. Effect of insurance on mortality in an HIV-positive population in care. J Am Stat Assoc. 2001;96:833-94. CrossrefGoogle Scholar16. Dor A, Sudano J, Baker DW. The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study. Health Serv Res. 2006;41:759-87. [PMID: 16704511] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the Department of Veterans Affairs and University of California, Los Angeles, Robert Wood Johnson Clinical Scholars Program and David Geffen School of Medicine at University of California, Los Angeles; Los Angeles, CA 90095.Disclosures: None disclosed.Corresponding Author: Giancarlo DiMassa, MD, Robert Wood Johnson Clinical Scholars Program, 911 Broxton Avenue, 3rd Floor, Los Angeles, CA 90095; e-mail. [email protected]ucla.edu.Current Author Addresses: Drs. DiMassa and Escarce: Robert Wood Johnson Clinical Scholars Program, 911 Broxton Avenue, 3rd Floor, Los Angeles, CA 90095. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChanges in Health Care Expenditure Associated with Gaining or Losing Health Insurance Lisa Ward and Peter Franks Metrics Cited ByEmergency Room (ER) Referrals and Health Insurance in the United StatesPolicy Dilemmas in Latino Health Care and Implementation of the Affordable Care ActHealth Expenditure Dynamics and Years of U.S. Residence: Analyzing Spending Disparities among Latinos by Citizenship/Nativity StatusChanging expenditure with changing health insurance status 5 June 2007Volume 146, Issue 11Page: 814-815KeywordsBlood pressureHealth careHealth insuranceHealth surveysPsychiatry and mental healthPublic policyVisionVisual acuity ePublished: 5 June 2007 Issue Published: 5 June 2007 CopyrightCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...