Letter to the Editor: Does health insurance equal good health?

Health insurance for all is a very desirable goal. However, it is important to keep in mind that having health insurance does not equal good health. It seems somehow counterintuitive, at first, as all the insurance plans have the word “health” in their title or among their stated goals. It is a well-researched public health fact that a dominant group of illnesses is related to what is termed behavioral/lifestyle factors and only we, individually, have the real control over the myriad of decisions that lead to a potential salubrious outcome.

“Health” as well as “care” are both complex issues but they need not be complicated and insurmountable. There is a large amount of good research already done on both topics. Below is one of them, an extract from a published research, dealing with the Affordable Care Act and its Medicaid component; the results may surprise some.

Expanding Medicaid: Mental and Financial Health Improve, but No Improvement Shown in Physical Health (Oregon Health Insurance Experiment).

In 2008, Oregon held a lottery to give additional low-income, uninsured residents access to its Medicaid program; about 90,000 individuals signed up for the lottery for the 10,000 available openings. Approximately two years after the lottery, the researchers conducted more than 12,000 in-person interviews and health examinations of lottery participants in the Portland, Oregon metropolitan area, and compared outcomes between those randomly selected in the lottery and those not selected in order to determine the impact of Medicaid.

Physical health … Medicaid had no significant effect on measures of hypertension or high cholesterol, or on the rates of diagnosis or use of medication for these conditions.

Mental health … Medicaid reduced rates of depression.

Financial hardship … Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures.

Utilization and access … Medicaid increased health care use.

Katherine Baicker, Amy Finkelstein. The Effects of Medicaid Coverage — Learning from the Oregon Experiment. New England Journal of Medicine, 2011; 365 (8): 683 DOI: 10.1056/NEJMp1108222 http://www.sciencedaily.com/releases/2013/05/130501193137.htm

Ivo P. Janecka, MD, MBA, PhD

Foundation for Systems Research and Education

New York/Dataw Island

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