Background
Although studies have examined both the adverse consequences of lacking health insurance
and the costs of insuring the uninsured, there are no estimates of the value of providing
health insurance to those currently uninsured.
Objective
To examine the value associated with providing insurance to those currently uninsured
through an incremental cost-effectiveness analysis.
Methods
People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality
follow-up) and the Medical Expenditure Panel Survey were examined to estimate the
contribution of sociodemographic, health, and health behavior characteristics on insured
persons’ quality-adjusted life years (QALYs) and healthcare costs. Parameter estimates
from these regression models were used to predict QALYs and costs associated with
insuring the uninsured, given their characteristics for 1996. Markov decision-analysis
modeling was then employed to calculate incremental cost-effectiveness ratios.
Results
The incremental cost-effectiveness of insurance for the average 25-year-old adult
(through age 64) is approximately $35,000 per QALY gained (range $21,000 to $48,000).
The incremental cost-effectiveness ratio becomes more favorable as people approach
age 65.
Conclusions
The additional health care purchased with health insurance provides gains in quality-adjusted
life at costs that compare favorably to those of other programs and medical interventions
society now chooses to fund.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tracking health care costs.in: Health Aff (Millwood). 2003: 266-274 (Jan–Jun; (suppl web exclusives))
- Health insurance coverage. U.S. Bureau of the Census, Washington DC2001 (Publication P60-220)
- Insuring America’s health. National Academies Press, Washington DC2004
- Draft 2003 report to Congress on the costs and benefits of federal regulations. Office of Management and Budget, Washington DC2003
- Foundations of cost-effectiveness analysis for health and medical practices.N Engl J Med. 1977; 296: 716-721
- Does free care improve adults’ health? Results from a randomized controlled trial.N Engl J Med. 1983; 309: 1426-1434
- Care without coverage. National Academies Press, Washington DC2002
- Mortality in the uninsured compared with that in persons with public and private health insurance.Arch Intern Med. 1994; 154: 2409-2416
- Health insurance and mortality. Evidence from a national cohort.JAMA. 1993; 270: 737-741
- Lack of health insurance and decline in overall health in late middle age.N Engl J Med. 2001; 345: 1106-1112
- Sicker and poorer—the consequences of being uninsured.Med Care Res Rev. 2003; 60 (, 76S–112S): 3S-75S
- Health insurance for low-income working families. Effect on the provision of immunizations to preschool-age children.Arch Pediatr Adolesc Med. 1997; 151: 798-803
- Impact of Medicare coverage on basic clinical services for previously uninsured adults.JAMA. 2003; 290: 757-764
- How much medical care do the uninsured use, and who pays for it?.in: Health Aff (Millwood). 2003: 66-81 (Jan–Jun; (suppl web exclusives))
- Cost-effectiveness in health and medicine.Oxford University Press, New York1996
- Reconciling medical expenditure estimates from the MEPS and the NHA, 1996.Health Care Finance Rev. 2001; 23: 161-178
- National Health Interview Survey, 1993. Centers for Disease Control and Prevention, National Center for Health Statistics, Atlanta GA2003
- National Death Index, 1995. Centers for Disease Control and Prevention, National Center for Health Statistics, Atlanta GA1995
- Medical Expenditure Panel Survey. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville MD1996
- The accuracy of the National Death Index when personal identifiers other than Social Security number are used.Am J Public Health. 1992; 82: 1145-1147
- Years of healthy life. Centers for Disease Control and Prevention, Atlanta GA1995
- Toward consistency in cost-utility analyses.Med Care. 1998; 36: 778-792
- Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients.Med Decision Making. 2000; 20: 314-322
- Using the years-of-healthy-life measure to calculate QALYs.Am J Prev Med. 2001; 20: 35-39
- The CEA Registry. Harvard University, Harvard Center for Risk Analysis, Cambridge MA2004
- Five hundred life-saving interventions and their cost-effectiveness.Risk Analysis. 1995; 15: 369-390
- Why are so many Americans uninsured?.in: McLaughlin C.G. Health policy and the uninsured. Urban Institute Press, Washington DC2004: 1-365
- Does skepticism towards medical care predict mortality?.Med Care. 1999; 37: 409-414
- Skepticism toward medical care and health care utilization.Med Care. 1998; 36: 180-189
- Hidden costs, value lost. National Acadamies Press, Washington DC2003
- A flexible benefits tax credit for health insurance and more.in: Health Aff (Millwood). 2002: 1-10 (suppl web exclusives)
- Liberal benefits, conservative spending. The Physicians for a National Health Program proposal.JAMA. 1991; 265: 2549-2554
- Canadian health insurance. Government Accounting Office, Washington DC1991 (GAO/HRD-91-90)
- Single-payer and all-payer health insurance systems using Medicare’s payment rates. Congressional Budget Office, Washington DC1993
- Inside the sausage factory.Milbank Q. 2002; 80 (, iii): 603-635
Article info
Identification
Copyright
© 2005 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
