Lifetime Consequences of Early-Life and Midlife Access to Health Insurance: A Review

Abstract

Over the past decade, the number of studies examining the effects of health insurance has grown rapidly, along with the breadth of outcomes considered. In light of growing research in this area and the intense policy focus on coverage expansions in the United States, there is need for an up-to-date and comprehensive literature review and synthesis of lessons learned. We reviewed 112 experimental or quasi-experimental studies on the effects of health insurance prior to people becoming eligible for Medicare on a broad set of outcomes. Over the past decade, evidence related to the effect of increased access to health insurance has strengthened, illuminating that children and vulnerable adults are most likely to see health and economic benefits. We identified promising areas for future study in this active and burgeoning research area, noting benefit design of health insurance and outcomes such as government program participation and self-reported health status as targets.

Keywords: experimental studies; health and economic outcomes; health insurance; quasi-experimental studies; review.

Figure 1.

Trade-off between leisure and consumption by availability of health insurance. Note. The dashed line represents a budget constraint when health insurance is unavailable. The solid line represents the availability of employer-sponsored insurance (Segment B) and public insurance (Segment C).

Figure 2.

Health production function and relation to insurance. Note. If individuals are at a relatively steep area of the function, as in Point A, health insurance is likely to have a measurable impact on health (e.g., moving from A to B). In contrast, if they are located at a flat area of the curve, as in B, then health insurance may have little effect on health.