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Thursday, April 10, 2014

Health Insurance, Socioeconomic Status, and Health

Earlier this week, I wrote about the link between health insurance and health and suggested that socioeconomic factors such as education and wealth can be much more important for health than access to health care. There are some interesting studies in this area.

For example, researchers looked at health outcomes in England under that country’s National Health Service (NHS) and found that the higher the socioeconomic status of a person, the lower the death rate. People in the highest civil service grade for government employees had a mortality rate about half that of people in the lowest civil service grade, even though they all had good access to health care. In addition, the gap in mortality rates among men in England by socioeconomic status has actually widened over time since the introduction of the NHS in 1948.

Or consider an interesting policy experiment in Canada during the 1970s. For four years, the province of Manitoba guaranteed a minimum annual income for all residents of Dauphin, a small, rural city. Health status improved significantly. When Dauphin residents were compared with residents of other rural communities in Manitoba, the data showed that while people in Dauphin were more likely to be hospitalized before implementation of the minimum income program, the gap in hospitalization rates disappeared by the end of the program. The decline largely occurred for hospitalizations that tend to be sensitive to levels of income security.

And the improvements in health status cannot be attributed to better access to health insurance. Manitoba had implemented a program of universal health insurance before the minimum income experiment, so the income benefits did not affect health insurance status.

U.S. data also illustrate the value of socioeconomic interventions for promoting health. Studies have found that the provision of housing for chronically homeless individuals decreases the  number of hospital admissions, shortens the duration of hospitalizations, and reduces  overall health care costs substantially.

No doubt there are important political reasons for dedicating dollars to improving health care coverage rather than socioeconomic status, but we’re not making the wisest investments with our limited resources. 

[cross-posted at HealthLawProfs and orentlicher.tumblr.com]

Posted by David Orentlicher on April 10, 2014 at 09:28 AM | Permalink


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