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

Overview• Background• Research Design• Findings• Implications

0%

5%

10%

15%

20%

Vermont

United States

UninsuredVermont vs. US

1990 1998

Research Model

Individual Factors

Evaluation of Costs/Benefits

Enrollment Decision

(-) Access Barriers

(+) Perceived Access

(+/-) Utilization

(+) Health Outcomes

(+) Satisfaction

Year before VHAP

enrollment

UNINSURED

Year after VHAP

enrollment INSURED

(+)

(-)

Selection Bias

11%

5%

19%

9%

Disabled Hospitalized

Enrollees Non-enrollees

Access Barriers

53%

18% 15%

3%

Cost Knowledge

Uninsured

Insured

15.0%

33.0%

31.0%

55.0%Uninsured

Delayed needed care

Did not get needed care

Insured

Access to Needed Care

Preventive Care Access

29%

11%

Preventive care

Went without needed preventive care

Uninsured After insured for 12 months

Access & 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

Hospitalization & ER DropDentist and Doctors’ Rise

19%11%

81%84%

28%21%

52%57%

Hospital** Doctor ER* Dentist

(-14%) (+12%) (-16%) (+30%)

Increase in mental health visits

(for those with at least one visit)

10.7

21.1

Visits

Uninsured After insured for 12 months

Average change is 1.44 (.016)

33%

43%UninsuredInsured

Average change is -22% (.000)

Health StatusReported a health

problem

Lessons• 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.

Final Thoughts…Vermont’s

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