Insurance and Behavior

The effect of health insurance on covered persons’ health behaviors and health care seeking behavior is of great interest to insurers, among others, because it impacts their price setting formulas and care management approach.  Research to date suggests that people who have health insurance tend to utilize more health care.  There has also been a theory that people who have insurance may engage in less healthy behaviors, since the cost of resulting care will be covered. A new study in the Journal of the American Board of Family Medicine examines the issue using data from the Medical Expenditure Panel Surveys.   (JABFM Article)    The researchers looked at over 75,000 respondents who had a least two years of data to ascertain if a change in insurance status, gain or loss, was associated with receipt of preventive care or with health behaviors.  They found that consumers who gained insurance coverage did receive more preventive care, such as flu vaccines, colorectal cancer screening, PAP tests, mammography and PSA tests.  But health behaviors did not appear to change, including use of seat belts, losing weight and quitting smoking.

This research is based on MEPS survey data, which is self-reported and therefore subject to accuracy concerns.  It also does not discern the exact nature of the benefit design, which can greatly affect behavior through deductibles and copays.  The high deductibles and copays of today’s “consumer-driven” health plans likely weaken the link between coverage and utilization of services, but preventive care is generally now required to be fully covered so cost should not affect decisions to seek those services. While there are weaknesses to the study, the conclusions and the authors’ explanations have a certain logic to them. It seems unlikely that people would intentionally decide to be less healthy just because it may not cost them as much, given the other personal consequences of poor health behavior.  And today’s insurance designs do, very appropriately, allow for charging a higher premium to people who don’t engage in wellness programs or who smoke, so there can often be a financial consequence for risky health behavior.