longer term outcomes that might emerge in later childhood, adolescence, or adulthood (Forrest and Riley, 2004).

In contrast, the body of evidence on the effects of uninsurance on adults’ health has strengthened considerably since 2002. Numerous studies have addressed some of the methodological shortcomings of past research. As discussed further below, 17 observational and 13 quasi-experimental rigorous analyses have reported significant findings related to health insurance and adults’ health (Table 3-3) (McWilliams, 2008). The quality and

TABLE 3-3 Overview of Studies of the Impact of Health Insurance on Adults’ Access to Health Care Services and Health Outcomes, 2002-2008

 

Significant impacta

No impact or impact is not statistically significanta

Number of observational studies

Number of quasi-experimental studies

Number of observational studies

Number of quasi-experimental studies

Access to health services

2

9

1

1

Preventive services

2

5

4

1

General health services

0

4

0

0

Health outcomes (all)

17

13

2

7

General health and physical functioning

3

6

0

2

Mortality

2

2

0

2

Cardiovascular disease and diabetes

4

1

0

0

Cancer

6

0

1

2

Depression

0

1

0

0

Acute conditionsb

2

3

1

1

NOTE: This table is based on a systematic review of research literature published between December 2001 and August 2008 on the consequences of uninsurance for adults. Altogether there were 42 studies. Several studies assessed more than one outcome or reported both significant and nonsignificant findings in separate analyses.

aStatistical significance is defined as P ≤ 0.05.

bAcute conditions include acute myocardial infarction, congestive heart failure, COPD or asthma exacerbation, hip fracture, respiratory failure, seizure, and stroke.

SOURCE: McWilliams (2008).



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