Risky Behaviors and Health Insurance Study
(SACRAMENTO, Calif.) -- People with health insurance are more likely to use preventive services such as flu shots and health screenings to reduce their risk of serious illness, but they are no more likely than people without health insurance to engage in risky health behaviors such as smoking or gaining weight, researchers at UC Davis and University of Rochester have found.
The findings, published in the November-December issue of the "Journal of the American Board of Family Medicine," contradict the common concern that expanding health-care coverage may encourage behaviors that increase utilization and costs.
"The notion that people with insurance will exhibit riskier behavior is referred to by economists as 'ex ante moral hazard' and has its roots in the early days of the property insurance industry," said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study. "After buying fire insurance, some people wouldn't manage fire hazards on their property. But health care is different. Someone might not care if their insured warehouse burns down, but most people want desperately to avoid illness."
Health Insurance Increases Preventive Care But Not Risky Behaviors
Jerant and his colleagues evaluated respondents in the Medical Expenditure Panel Survey, a source of national data on the costs and uses of health care. They included adults who entered the survey between 2000 and 2008, participated for two years and had insurance at least once during those two years of participation. The team then compared data on 96,021 respondents while they were insured to data on them while they were uninsured.
Specifically, the team compared health behaviors that are often detrimental to health such as smoking, seat belt use and weight gain. They also focused on use of preventive care services that are intended to protect health, including flu vaccinations, colorectal cancer screenings, mammography, pap smears and PSA (prostate-specific antigen) tests. In addition, the researchers examined numbers of office visits, prescriptions and other expenditure metrics.
The results showed that changes in health insurance status were closely linked to preventive care, which increased with coverage and decreased without it. The gain or loss of coverage, however, had no significant relationship to changes in health behaviors. This contradicts a belief long-held by some health economists that mandating the purchase of health insurance coverage may increase risky behavior. While this belief is at odds with the experiences of many physicians, this is the first time the relationship has been vigorously investigated in a national sample of adults of all ages.
"There has been a concern that people would say, 'Hey, I have insurance now, I don't have to worry about my diet. If I get heavy and develop a problem, I can just go to a doctor and have it treated,'" said Jerant. "Empirically, we find that's not the case. Health insurance coverage did not worsen the health habits we studied."
"These results do show that having health insurance affects the likelihood of receiving important preventive services that can potentially reduce the chance of an influenza-related hospitalization or death and prevent or detect colorectal or cervical cancer," said co-author Kevin Fiscella, professor of family medicine at the University of Rochester School of Medicine. "This is a critical message, as many states continue to debate whether to expand Medicaid."
While the results of this study generally support the broad intent behind the Affordable Care Act (ACA) to expand insurance coverage as one means to encourage preventive care, Jerant urges caution.
"The people in our study voluntarily acquired health insurance, while the ACA is mandatory," he said. "We will need to verify whether our findings apply to mandatory coverage."
"People may behave differently when coverage is mandated."
In addition, the study does not address why gaining insurance improves receipt of preventive care but not health behaviors that can have profound health effects. The authors suggest that this may result from clinicians having a greater vested interest in preventive interventions, which are more directly under the clinicians' control and easier to bring about than sustained lifestyle changes. The authors also point out that studies have found that clinical efforts to encourage weight control, seat belt use and smoking cessation have limited efficacy.
While preventive care increased for those with insurance, that increase was not uniform across different types of care. For example, insurance increased cancer screenings, such as colonoscopies, much more than flu shots. The authors hypothesize this may be due to differences in cost and access, as vaccines are relatively inexpensive for uninsured people to buy and are widely available in many workplaces, drugstores and other places -- not just in health-care facilities
Ultimately, the study findings counter a theoretical barrier to health insurance expansion.
"Now we have empirical evidence that patients don't change the health behaviors we studied as a consequence of changes in their health insurance alone, and we've confirmed that insurance encourages people to get vaccinations and cancer screenings," Jerant said. "In other words, insurance works."
In addition to Jerant and Fiscella, study authors were Daniel Tancredi and senior author Peter Franks of UC Davis. The research had no external funding. A copy of the study is available at http://jabfm.org/content/26/6/759.full.
Print This Article
Placer County News HeadlinesRoseville Shooting Leads to Arrest of Sacramento TrioAt 7:45 p.m. April 16, officers responded to a report of shots fired from a car toward another car in the area of Pleasant Grove Boulevard and Fairway Drive.
Roseville Crime Report Digest (4-17-14)The Roseville Police Department's Crime Report Digest for April 17, 2014.
John and Marilyn Redding Recipients of 2014 Public Safety Leadership Award John and Marilyn Redding were this year's recipients of the Public Safety Leadership Award, which was presented to the Rocklin couple at the third annual Victim's Rights Breakfast.
Your Aging Genes and Risk of DementiaUC Davis Alzheimer's Disease Center Director Charles DeCarli will discuss "Your aging genes: What you need to know about your risk for dementia" during the Community Discovery Lecture Series on Thursday, May 8
America's ClayFest II in RosevilleThe Art League of Lincoln in conjunction with Blue Line Arts will be holding the second annual art show and competition at the beautiful Blue Line Arts in Roseville, CA
Placer Pops Chorale Spring Concert SeriesTickets are still available for the popular Placer Pops Chorale Spring Concert Series, directed by Lorin Miller, but hurry - they're going fast!
Chocolate Fest in Paradise May 10thExperience a chocolate paradise on the Paradise/Magalia ridge nestled among tall green pines in the foothills of the Sierra Nevada Mountains and overlooking the Sacramento Valley
Big DoG Countdown: Soldiers ProjectBig DoG Countdown: Learn how Soldiers Project impacts your community.
Big DoG Countdown: KidsFirstBig DoG Countdown: Learn about how KidsFirst impacts your community.
End of Life Planning: A Difficult Subject for ManyIt is often difficult to imagine your end of life care-or end of life care for a loved one-in the event you or your loved one becomes incapable of making health care decisions.
STEM Collaborative Teaches Critical ThinkingAt the final session of the Sierra College STEM Collaborative ACTivATE nine-month professional development program on teaching applied critical thinking, Sierra College and high school instructors reported
Northern California National Day of Prayer BreakfastThis year's keynote speaker is atheist-turned-Christian Lee Strobel, the former award-winning legal editor of The Chicago Tribune. He is a New York Times best-selling author of more than twenty books