DataWatch: Impact Of Extending Health Care Coverage To The Uninsured

Changes in use of health services by the uninsured, when covered after health reform, are a key to the costs of reform. From data on persons under age sixty-five in the 1989 National Health Interview Survey, we estimated their expected use of hospitals (excluding obstetric deliveries) and doctor visits, adjusting for age, sex, and self-reported health status. If uninsured persons obtained private coverage distributed by the plan type of other persons in their home regions, nonobstetric hospital days for the formerly uninsured would increase 28 percent, and their visits to physicians’ offices would increase 52 percent. If instead the uninsured enrolled entirely in groupor staff-model health maintenance organizations (HMOs) in their home regions, their nonobstetric hospital days would actually decrease 17 percent, and their visits to physicians’ offices would increase 60 percent. One key goal of health system reform is to provide health care coverage to those who now lack it. Estimating the cost of providing such coverage is an important policy issue. These estimates depend greatly on how much the volume of health care services used by the uninsured would change if they were to enroll in various types of private health coverage. Obviously, somebody in the system is paying the costs of care already obtained by the uninsured. If the uninsured were covered, these costs would appear explicitly instead of remaining hidden. Regional patterns of health care use also affect the changes in cost incurred when coverage is extended to the uninsured. However, much of our current knowledge of relative utilization by persons with various types of private coverage depends on data gathered ten to twenty years ago. A study based on a more recent nationally representative sample should provide further insights for policymakers on how to resolve this tough issue. The 1989 National Health Interview Survey (NHIS) included a supplementary set of questions that asked for considerable detail on types of health coverage for the survey population. This information, combined with the regular NHIS questions concerning health status and use of physician and hospital services, made it a very promising source of comprehensive factual information on the issues mentioned above. The major objective of this study was to use information from the 1989 Mark Blumberg recently retiredas director of special studies for the Kaiser Foundation Health Plan, Inc., in Oakland, California. on S etem er 6, 2017 by H W T am H ealth A fairs by http://conealthaffairs.org/ D ow nladed fom 182 HEALTH AFFAIRS | Winter 1994 NHIS to examine volumes of hospital and physician’s office use adjusted for age, sex, and self-reported health status of the population under age sixty five without public coverage, comparing those without private health coverage to those with various types of private health coverage, by region.