NCPA - National Center for Policy Analysis

Does Health Insurance Determine One's Health?

August 21, 2002

It is frequently said that the uninsured have less access to health care and worse health outcomes. However, there is evidence that poverty and lack of education may be a cause of both poor health and non-insurance. If that is true, increasing the access of the poor to health insurance may not improve their health as much as some hope it would.

For example, a recent survey of the United States and four other English-speaking countries perceived to have some version of "universal" health insurance found that many more people with below-average incomes report poor health than do higher-income people.

  • In the United States, for example, 37 percent of below-average-income adults said they were in fair or poor health, while only 9 percent of above-average-income people said the same.
  • By comparison, in the United Kingdom the ratio of low income to higher income adults reporting themselves in fair or poor health was 31 percent to 10 percent.

If insurance were the primary factor in determining health status, these income disparities should disappear in countries with universal health care -- but they don't.

  • Similarly, within the United States, people on Medicaid are both low income and well insured; yet Medicaid recipients appear to do about as badly or worse than the uninsured in receiving health care services or maintaining good health.
  • And among Medicare enrollees, who are covered by the same insurance program regardless of their incomes, those with low incomes are twice as likely to report poor health as those with higher incomes.

Studies have also found a strong correlation between poor education and poor health for most conditions.

The fact is that people with low incomes and limited education have worse health than the rest of the population.

Source: Greg Scandlen (senior fellow in health policy), "Health Insurance: How Much Does It Matter?" Brief Analysis No. 416, August 21, 2002, National Center for Policy Analysis.


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