Abstract
Purpose: Strong evidence supports the relationship between health coverage and improved health status. Little is known about the lasting impact of prior health insurance on the prior insured's use of health services. We aimed to examine the association between prior insurance status and health service utilization (HSU) among the long-term uninsured (LTU) in South Carolina.Methods: The current study used data from in-person interviews of the LTU collected in a 2014 cross-sectional South Carolina survey. Men and women between 18–64 years of age who reported not having health insurance for at least 24 months at the time of data collection were included. Propensity score analysis was used to examine the associations between prior insurance status and three outcome variables: (1) having a usual source of care, (2) HSU, and (3) delaying health care needs.Results: Prior health insurance significantly predicted a greater likelihood of having a usual source of care (effect size: 9.2%, p=0.004) and having had at least one preventive visit during the past 2 years (effect size: 6.4%, p=0.035). Prior insurance coverage was positively associated with delayed health care utilization, but the result was not statistically significant (p=0.703).Conclusions: Among the LTU, ever having insurance coverage was positively associated with having a usual source of care and HSU. The lasting impact of insurance coverage on HSU behavior extends beyond the period of insurance coverage, which provides a more comprehensive and deeper understanding of the long-term implications of national and local efforts in expanding insurance coverage.
Highlights
Strong evidence supports the relationship between health insurance, health service utilization (HSU), and improved health status
For participants who reported ever having health insurance (n = 624), 14.1% reported coverage 24–25 months prior, and 85.1% reported that they had coverage 36 months prior or more
The current study used primary data collected from the long-term uninsured (LTU), a hard-to-reach population in the state of South Carolina, and is among the first to demonstrate the necessity of evaluating the benefit of health insurance on long-term HSU outcomes among the LTU
Summary
Strong evidence supports the relationship between health insurance, health service utilization (HSU), and improved health status. Having a usual source of care is often the cornerstone of health care that facilitates prevention, continuity of care, and chronic disease management.[1,2,3,4,5,6,7] health insurance and subsequent utilization are critical to maintaining health as it encompasses both preventive care and the treatment of illnesses.[8] Previous research on the benefits of having a usual source of care[1,9,10,11] and more recent findings on the benefits of patient centered medical homes,[12,13] support the patient–provider relationship as being an access point for preventative health services.
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