• The effect of health insurance on utilization

    Here’s the abstract of The Effect of Health Insurance Coverage on the Use of Medical Services, by Michael Anderson, Carlos Dobkin, and Tal Gross

    Substantial uncertainty exists regarding the causal effect of health insurance on the utilization of care. We exploit a sharp change in insurance coverage rates that results from young adults “aging out” of their parents’ insurance plans to estimate the effect of insurance coverage on the utilization of emergency department (ED) and inpatient services. Aging out results in an abrupt 5 to 8 percentage point reduction in the probability of having health insurance. We find that uninsured status leads to a 40 percent reduction in ED visits and a 61 percent reduction in inpatient hospital admissions.

    In the following chart, you can see the aging out effect around age 19, which coincides with a decrease in ED visits and sharp break in the rate of change in hospitals stays.

    A regression-discontinuity analysis focused on age 19 yields the following results.


    • At 19 is there a sharp spike in ER and inpatient utilization due to lack of coverage but over time a compensation for the lack of coverage that results in a quick drop of this utilization? A learning curve of how to avoid this type of health system access?

    • Even if it only survives two years, The ACA provision allowing children to stay on their parent’s insurance to 26(?) would seem to create a lot of opportunities for similar research.