Outcomes/Effectiveness Research

People with insurance use more health care services and have better health outcomes

The question of whether people who have health insurance use more health care services has been studied in-depth since the RAND Health Insurance Experiment study was published 30 years ago. Notably, the study found that when people were asked to share costs for medical care through copayments, they reduced the amount of services they used but the reduction did not affect health outcomes. To determine if the RAND study's findings have held true over time, researchers from the University of Washington systematically reviewed more than 9,700 studies published since 1991. They located 14 studies that delved deeply into the effect of insurance status on health care use and health outcomes.

Like the RAND study, the authors found that higher copayments were linked to fewer visits to physicians. However, in contrast to the RAND study, they did not find that having insurance increased people's visits to emergency departments or hospitals. They also found that having health insurance brings better health for most people, especially those who have recently been diagnosed with a disease.

The authors suggest that policymakers need to have a firm understanding of the effect of health insurance on health care use and outcomes if they want to promote health successfully. This literature review shows that providing health insurance to the uninsured will both increase health care use and improve health. This study was funded in part by the Agency for Healthcare Research and Quality (HS13853).

See "The causal effect of health insurance on utilization and outcomes in adults: A systematic review of U.S. studies," by Joseph D. Freeman, B.A., B.S., Srikanth Kadiyala, Ph.D., Janice F. Bell, M.N., M.P.H., Ph.D., and Diane P. Martin, Ph.D., in the October 2008 Medical Care 46(10), pp. 1023-1032.

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