The Impact of Being Uninsured in the United States on Economic and Humanistic Outcomes: Results from the 2004-2008 Medical Expenditure Panel Surveys

<p>Objectives: The purpose of this dissertation was to describe the extent of the uninsured problem in the United States for the non-elderly population, and for various subpopulations. The objectives were 1) for specific cohorts within the United States non-elderly population, compare humanistic and economic outcomes between continuously insured individuals and uninsured individuals and 2) for the United States non-elderly population, explain case-control-paired differences in humanistic and economic outcomes by individual and uninsured characteristics.</p><p>Methods: This study was a retrospective observational study. The study population consisted of 4,246 children, and 13,426 adults using combined 2-year longitudinal data from the Medical Expenditure Panel Surveys (MEPS) from 2004-2008. A 1:1 nearest-neighbor-with-replacement case-control design (matching on age category, race, region, health status, average risk aversion, job loss to injury or illness, income category as a percent of the federal poverty level change in health, year participating in the study, and chronic condition(s)) was used to match an uninsured (case) with an insured (control) individual using four two-year panels from the MEPS from 2004-2008. The Student’s paired t-test test was used to compare the mean number of visits and mean expenditures between cases and controls for specific types of medical care during uninsured periods for the case. Ordinary-least-squares regression models to explain the size of the difference between case and control were estimated, accounting for the complex sample design of the MEPS. </p><p>Results: Uninsured adults, on average, spent statistically significantly less on both preventative (office and outpatient) and acute care (emergency room and inpatient) during periods without insurance coverage relative to the continuously insured from 2004-08. Uninsured adults, on average, spent $38.16 (p < 0.01) less per month on office-based care compared to continuously insured adults during periods without coverage. Similarly, adults without health insurance coverage spent $13.74 (p < 0.01), $3.22 (p < 0.01), and $52.72 (p < 0.01) less per month on outpatient, emergency room, and inpatient care, respectively, relative to continuously insured adults during periods without insurance coverage. The following types of adults had a statistically significant negative effect on the paired difference between case-control associated with their lack of coverage relative to other types of individuals for expenditures per month for office care: individuals with one chronic condition relative to individuals with no chronic conditions and individuals with more than one chronic condition relative to individuals with no chronic conditions. </p><p>Conclusions: There is an inherent tradeoff between the costs associated with providing health insurance coverage to the uninsured and the potential improved quality of life associated with providing health insurance coverage to the uninsured. On the one hand, individuals who have health insurance coverage, on average, tend to spend and use more medical care compared to individuals without health insurance coverage. On the other hand, being uninsured, particularly for individuals with one or more chronic conditions, has negative health consequences, as individuals are likely to be unable to get and delay getting necessary medical care as a result of being uninsured.</p>

Name thesis:degree_name

PhD

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Pharmacy: Pharmaceutical Sciences/Biopharmaceutics

Grantor dc:publisher

University of Cincinnati

Year dc:date

2012

Author dc:creator

• Berry, Edmund A.

Contributors dc:contributor

• Heaton, Pamela

• Pharmaceuticals
• Health Insurance
• Economic
• Gap
• Humanistic
• Medical Expenditure Panel Survey

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353154260

OAI identifier oai:identifier

oai:etd.ohiolink.edu:ucin1353154260