Title: The Power of Health Insurance On the Lives of The effectiveness of the Vermont Health Access Plan Catherine Hamilton, Ph.D. New York University Blue Cross and Blue Shield of Vermont
1The Power of Health Insurance On the Lives of
The effectiveness of the Vermont Health Access
PlanCatherine Hamilton, Ph.D.New York
UniversityBlue Cross and Blue Shield of Vermont
2Overview
- Background
- Research Design
- Findings
- Implications
3UninsuredVermont vs. US
20
United States
15
10
Vermont
5
0
1990 1998
4Research Model
Evaluation of Costs/Benefits
Individual Factors
Enrollment Decision
(-) Access Barriers
() Perceived Access
Year before VHAP enrollment UNINSURED
Year after VHAP enrollment INSURED
()
(/-) Utilization
() Health Outcomes
(-)
() Satisfaction
5Selection Bias
19
11
9
5
Disabled
Hospitalized
Non-enrollees
Enrollees
6Access Barriers
Uninsured
Insured
15
3
Cost
Knowledge
7Access to Needed Care
8Preventive Care Access
9Access Use
- Members
- unable to find doctors accepting insurance less
likely to seek preventive care - with long appointment waits and unmet health care
needs twice as likely to end up in the hospital - with unmet needs 1.4 times as likely to visit the
ER
10Hospitalization ER DropDentist and Doctors
Rise
(-14)
(12)
(-16)
(30)
11Increase in mental health visits (for those with
at least one visit)
Average change is 1.44 (.016)
12Health StatusReported a health problem
Uninsured
Insured
Average change is -22 (.000)
13Lessons
- Initiating insurance in a rural setting improved
psychological physical well-being. - Could be cheaper, too!
- Program successfully targeted uninsured with the
greatest needs. - Benefit design, enrollment process influence
selection - Inverse relationship between perceived access and
hospital use. - Mental health status of males improved
significantly.
14Final ThoughtsVermonts Opportunities
- Sustaining the financing of the program over time
and reaching the final 10 uninsured - Rethinking
- how to pay for and manage the care of acutely ill
members - how to promote access within the individual
market - how to finance health care for the uninsured