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Wehby GL, Shane D. Genetic variation in health insurance coverage. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2019; 19:301-316. [PMID: 30421388 DOI: 10.1007/s10754-018-9255-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/03/2018] [Indexed: 06/09/2023]
Abstract
We provide the first investigation into whether and how much genes explain having health insurance coverage or not and possible mechanisms for genetic variation. Using a twin-design that compares identical and non-identical twins from a national sample of US twins from the National Survey of Midlife Development in the United States, we find that genetic effects explain over 40% of the variation in whether a person has any health coverage versus not, and nearly 50% of the variation in whether individuals younger than 65 have private coverage versus whether they have no coverage at all. Nearly one third of the genetic variation in being uninsured versus having private coverage is explained by employment industry, self-employment status, and income, and together with education, they explain over 40% of the genetic influence. Marital status, number of children, and available measures of health status, risk preferences, and prevention effort do not appear to be important channels for genetic effects. That genes have meaningful effects on the insurance status suggests an important source of heterogeneity in insurance take up.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, University of Iowa, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N250, Iowa City, IA, 52242-2007, USA.
- Department of Economics, University of Iowa, Iowa City, IA, USA.
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA, USA.
- Public Policy Center, University of Iowa, Iowa City, IA, USA.
- National Bureau of Economic Research, Cambridge, MA, USA.
| | - Dan Shane
- Department of Health Management and Policy, University of Iowa, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N250, Iowa City, IA, 52242-2007, USA
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Gottschalk FCH. Why prevent when it does not pay? Prevention when health services are credence goods. HEALTH ECONOMICS 2019; 28:693-709. [PMID: 30815954 DOI: 10.1002/hec.3874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/05/2018] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
This article identifies information asymmetries and the corresponding problem of overtreatment as a possible source of prevention and health disparities when patients differ with respect to their health risk. It analyzes preventive health behavior (primary prevention) and preventive health-care utilization (secondary prevention) in markets in which patients cannot determine whether they receive excessive secondary preventive treatment-that is, where health services are credence goods. The problem of overtreatment in such markets is considered as a possible pathway through which differences in health risk lead to disparities in primary and secondary prevention as well as the corresponding health outcomes. Patients with high health risks do not invest in primary prevention, because they anticipate to be provided with unnecessary secondary prevention. Patients with lower risks invest in primary but not in secondary prevention, resulting in health losses. Furthermore, when societal groups differ with respect to their exposure to overtreatment, and we consider socioeconomic status as a possible reason, we observe disparities in primary and secondary prevention as well as the resulting health outcomes, including the "social gradient." Several implications for empirical research are discussed.
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Affiliation(s)
- Felix C H Gottschalk
- Department of Management, Technology, and Economics (D-MTEC), Center of Economic Research (CER-ETH) ETH Zurich, Zurich, Switzerland
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Raymakers AJN, Gillespie P, Murphy E, Cupples ME, Smith SM, Murphy AW, Griffin MD, Benyamini Y, Byrne M. Patient reported health status and all-cause mortality in patients with coronary heart disease. Fam Pract 2018; 35:172-178. [PMID: 29092028 DOI: 10.1093/fampra/cmx094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Patients with coronary heart disease (CHD) experience reduced quality of life which may be associated with mortality in the longer term. This study explores whether patient-rated physical and mental health status was associated with mortality at 6-year follow-up among patients with CHD attending primary care in Ireland and Northern Ireland. METHODS This study is a secondary data analysis of patients with CHD recruited to a cluster randomized controlled trial from 2004 to 2010. Data collected included patient-rated physical component summary (PCS) and mental component summary (MCS) scores of health status (from the 12-Item Short-Form Health Survey (SF-12)), demographics and clinical parameters at baseline, and all-cause mortality at 6-year follow-up. Multivariate regression was conducted using generalized estimating equations (GEE) with a log-link function. Results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The study consisted of 762 individuals with mean age 67.6 years [standard deviation (SD): 9.8], and was 29% female. Mean baseline SF-12 mental (MCS) and physical (PCS) component scores were 50.0 (SD: 10.8) and 39.6 (SD: 11.2), respectively. At 6-year follow-up, the adjusted OR for the baseline MCS for mortality was 0.97 (95% CI: 0.95-0.99) and for the PCS 0.97 (95% CI: 0.95-0.99). For every five-point increase in MCS and PCS scores, there was a 14% reduction in the likelihood of all-cause mortality. CONCLUSIONS Overall, the magnitude of effect for both mental health status and physical health status was similar; higher scores were significantly associated with a lower risk of mortality at 6-year follow-up.
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Affiliation(s)
- Adam J N Raymakers
- CÚRAM SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.,Health Economics and Policy Analysis Centre, Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Paddy Gillespie
- CÚRAM SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.,Health Economics and Policy Analysis Centre, Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Edel Murphy
- HRB Primary Care Clinical Trials Network Ireland, Galway, Ireland
| | - Margaret E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, Northern Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew W Murphy
- HRB Primary Care Clinical Trials Network Ireland, Galway, Ireland.,Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Matthew D Griffin
- CÚRAM SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.,Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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Simon K, Soni A, Cawley J. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2017; 36:390-417. [PMID: 28378959 DOI: 10.1002/pam.21972] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health.
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Affiliation(s)
- Kosali Simon
- School of Public Health and Environmental Affairs, Indiana University, Bloomington, IN, USA.
| | | | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
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