Changes in Health Care Expenditure Associated with Gaining or Losing Health Insurance

5 June 2007 | Volume 146 Issue 11 | Pages 768-774

Background: Cross-sectional data suggest that changes in health insurance status are associated with expenditures. No national longitudinal analysis has examined this relationship.

Objective: To evaluate the association between changes in health insurance status and expenditures.

Design: Cohort analyses using the 2000 to 2003 Medical Expenditure Panel Surveys.

Setting: U.S. civilian noninstitutionalized population.

Participants: Three 2-year cohorts that included 20 848 adults age 21 to 64 years who were stratified by insurance type (private, public, military, or none): 17 130 participants were insured in both years, 342 participants were insured in year 1 and were uninsured in year 2, 385 participants were uninsured in year 1 and were insured in year 2, and 2991 participants were uninsured in both years. Persons who were insured for longer than 2 months but less than 10 months or who switched insurance type were excluded (n = 4039).

Measurements: Annual health care expenditures (any or none; amount, contingent on any expenditure; and the difference between year 1 and year 2).

Results: Adjusted expenditure probabilities were similar among all participant groups while insured and were higher than those for all participant groups while uninsured: 92.1% (95% CI, 91.4% to 92.7%) in year 1 and 91.8% (CI, 90.9% to 92.5%) in year 2 for persons insured in both years, 74.2% (CI, 71.7% to 76.5%) in year 1 and 74.8% (CI, 72.1% to 77.4%) in year 2 for persons uninsured in both years, and 90.7% (CI, 87.1% to 93.4%) for persons insured in year 1 and 74.6% (CI, 69.4% to 79.2%) for persons uninsured in year 2. The pattern was also consistent for the group that was uninsured in year 1 but insured in year 2. Adjusted annual expenditures among all participant groups with insurance were similar; expenditures among participant groups without insurance were similar but were lower than those among participants with insurance. Consistent differences in expenditures between year 1 and year 2 were observed for all groups.

Limitation: Few participants changed insurance status.

Conclusion: Changing insurance status is associated with changes in expenditures to levels that are similar to those for persons who are continuously insured or uninsured.

Editors' Notes Context Health economists hypothesize that persons who gain health insurance after being uninsured may use care at a higher level after receipt of insurance than do those who are continuously insured. Contribution This study examined heath care expenditures during 2 years for 3 groups: continuously uninsured persons, continuously insured persons, and persons in transition from no insurance to insurance or vice versa between the first and second year. Expenditures were higher during insured than during uninsured years. However, expenditures for newly insured persons were similar to those for continuously insured persons. Implication Among uninsured persons who become insured, health care expenditures do not seem to increase above those of continuously insured persons. —The Editors

 

Author and Article Information

From the University of California, San Francisco, San Francisco, California, and University of California, Davis, Sacramento, California.

Acknowledgments: The authors thank Patrick Romano, MD, MPH, for insightful comments on this manuscript. They also thank the Center for Health Services Research in Primary Care, specifically, members of the Primary Care Outcomes Research Seminar at University of California, Davis, for constructive feedback on this project.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lisa Ward, MD, MScPH, MS, Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, Ward 83, San Francisco, CA 94110; e-mail, lward{at}fcm.ucsf.edu.

Current Author Addresses: Dr. Ward: Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, Ward 83, San Francisco, CA 94110.

Dr. Franks: Center for Health Services Research in Primary Care, Department of Family and Community Medicine, University of California, Davis, 4860 Y Street, Suite 2300, Sacramento, CA 95817.

Author Contributions: Conception and design: P. Franks.

Analysis and interpretation of the data: L. Ward, P. Franks.

Drafting of the article: L. Ward, P. Franks.

Critical revision of the article for important intellectual content: L. Ward, P. Franks.

Final approval of the article: L. Ward, P. Franks.

Statistical expertise: L. Ward, P. Franks.

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