Health Insurance Doesn’t Necessarily Mean Better Health

Health Insurance Doesn’t Necessarily Mean Better Health

50
SHARE

By JIM MARKS, MD MPH

A new study in the influential policy journal Health Affairs gives added credence to the idea that much of what drives health falls outside of the realm of medical care. In fact, this must-read study points out what so many of us know: that simply providing someone a health insurance card is not enough to make them healthy.

What better place to test this theory than in Canada – our northern neighbor with a publicly financed universal health care system. Researchers looked at nearly 15,000 Canadians in the nation’s health system who were free of heart disease and tracked them for at least a decade.  Not surprisingly, people disadvantaged by little education and low income, used the health care system more than those with higher incomes. But more importantly, this increased use of services had no discernable effect on improving their health or cutting their death rates – the ultimate bottom line – when compared with others with higher education, higher income and LESS usage of health care.

Almost all of the debate about health care here has been about how many Americans will be covered, for what care, and at what cost. The results of this Canadian study are clear. It may be helpful to have insurance to get care, but the United States cannot expect that giving people medical care will diminish differences in health outcomes or the likelihood of an early death among disadvantaged people. The authors explicitly warn against relying on universal coverage to eliminate inequalities in health.

Although genes and medical care are vitally important, we’re increasingly understanding that where we live, learn, work and play affect our health even more. That is clearly what we saw last year when we released the first look at what factors affect health in every county of the nation.

When we release the new 2011 County Health Rankings in late March, we will see once again that the county you live in, and things like the extent of a person’s education, the quality of the air where they live, and access to healthy foods, can affect how healthy someone is and how long they will live. The good news is that these community and social characteristics that influence health so dramatically  can themselves be greatly influenced by policies and actions in communities working together to build safer neighborhoods, improve access to nutritious foods, ensure that people live in safe housing and provide quality education for their kids. Using these characteristics as a measure, we know more about how healthy a community is as a place to live.


Let’s take an example of a new type of program called Health Leads, where doctors act to remove the social barriers that get in the way of people taking the actions they need to be healthy. In addition to dispensing traditional medical therapies, doctors in these clinics also literally issue prescriptions for food or heating assistance to struggling families, or stable housing for a single mom that does not exacerbate her son’s asthma. A team of college volunteers then helps connect vulnerable families to those community resources that can immediately benefit their health.

The Health Affairs study adds to the mounting evidence that investing in public health, and those non-medical factors that are key to preventing disease and promoting healthy behaviors, is as essential to creating a healthy nation as expanding access to medical care. We have to be honest with ourselves that good health begins, and is nurtured and sustained, in our homes, neighborhoods, workplaces and schools. And if we are serious about bending the cost curve, we have to stop focusing just on treating disease after damage to our health has occurred and focus more of our efforts on preventing it.

To read the article “Lesson from Canada’s Universal Care: Socially Disadvantaged Patients Use More Health Services, Still have Poorer Health,” visit healthaffairs.org.

James S. Marks, M.D., M.P.H., is a senior vice president at the Robert Wood Johnson Foundation. He directs the Foundation’s public health work, including the County Health Rankings, which was launched in 2010 in partnership with the University of Wisconsin Population Health Institute.

Leave a Reply

50 Comments on "Health Insurance Doesn’t Necessarily Mean Better Health"


Guest

[…] difficulties building better health, contact me here for a free session of Theta Healing.  [caption id="attachment_2596" align="alignleft" width="300" caption="Will you wait to be old to move… alt="Building better health" width="300" height="225" />[/caption] Today's tip to building better […]

Guest

[…] OUR INTERNATIONAL SITEThe beginning of cellular regeneration is important to helping you maintain optimum health. For inst…in optimum health. For instance daily contact with to environmental toxins, over-exertion, bad diet, […]

Guest

[…] Health Insurance Doesn't Necessarily Mean Better Health | The .Mar 8, 2011 47 Responses for Health Insurance Doesn't Necessarily Mean Better Health. Vijay Goel, MD says: […]

Guest
Mar 24, 2011

Well.. that’s partly true.. yet, in most developing countries, the title statement should be reconsidered..

Guest
Mar 23, 2011

I agree that “simply providing someone a health insurance card is not enough to make them healthy.” I believe that all people should be approached when treated not from the point of view of health insurance, but should be treated the same way.

Guest
nate ogden
Mar 16, 2011

Nice try Peter Wolfe,

” Instead we blame the poor for being lazy or drunks/drug addicts. ”

We don’t blame the poor we blame the lazy and drunk/drug addicts for being lazt drunk/drug addicts. Its people like you that try to twist the argument for your political benefit. Why are you so intent on giving the lazy and drunk/drug addicts a free pass?

Since your not able to manage your life you want someone to do it all for you? Not very American or Christian.

Guest
Peter Q Wolfe
Mar 15, 2011

It’s funny how the insured typically say that “Poor or unfortunant people don’t deserve health care” cause f factors beyond their control not personal responsibility. Is it your ult that you don’t know enoug cause of statistics, genetics, accidents, quality of educatio, crime rates, single parent households, etc? Crazy to think of the U.S.A as a christian naation with the upmost christian values when our actions don’t refledct anything. Instead we blame the poor for being lazy or drunks/drug addicts. Sadly that my sister who has no health care cannot get counseling or rehabilitation cause of the for profit health care industry even today cause of the inequalities of the U.S.A.

Finally, I think health care investments can be in people on their personal life care. Waht we need is a doctor who is also a psychologist not a mechanic cause humans are not machines. We happen to have mental issus resolving the issues of our day. For example, the nurse could be a nutritional assistant as well and we could save by ivesting in nurses not ddoctors. Most things a rn can do what doctor cannot anyways. My motehr was a nurse in Mckinney, Texas for a while, so I have some insights. Another thign we need o regulate food like fast food restaurants in our communities by eliminati of these taking advantage of the poor i the ly way of doing this. Profitxs don’t come before people is what I say. If that means economics must slow, then let them slow and good riddens for it. Another thing is that we need to educate peopl with more requirements and quit talking down to people about things. For example, all welfare recipentss need to be reqired to have a library with manditory education tests on nutrition, english, and government with economics to understand things not havin access to the stupid cable television on public dime is hat I say.

Guest

It’s not just about providing more Americans with better health care. It’s also about getting Americans to care more about their health before it becomes an issue that requires health insurance. The better we take care of ourselves the less frequently we are going to need to see a doctor for much more than a check-up.

Guest
Barry Carol
Mar 3, 2011

“I am sure you are not suggesting that hospitals decrease pay to the RN’s.”

Hospital_RN – I am absolutely NOT suggesting any decrease in pay for RN’s.

Since a significant portion of inpatient hospital care is attributable to cases other than surgeries, I suspect that we may do a lot more testing here using more expensive and redundant equipment to reach a definitive diagnosis when we don’t know exactly what is wrong with the patient upon admission. We may also have more private rooms and other expensive amenities. Defensive medicine is probably a factor as well. We know that doctors generally earn considerably more in the U.S. than their counterparts abroad. Hospitals in other countries may have higher average occupancy rates which help to spread fixed costs over a broader patient base. Or, the price differences may have more to do with how hospitals are financed. As I noted earlier, Swiss hospital operating costs are partially covered by general tax revenue leaving less to be covered by bills to insurers and patients. Finally, Medicaid rates are well below actual costs, on average, which has to be made up by cost shifting to private payers, and many hospitals also claim that even Medicare rates do not fully cover their costs either. The bottom line is that it’s a complicated issue. I don’t know either the root cause of the large hospital price differences between the U.S. and other developed countries or how to narrow them materially without putting many of our hospitals out of business.

Guest
Hospital_RN
Mar 19, 2011

Phew!

Guest
Peter
Mar 3, 2011

“I have never seen a good analysis that compares the cost of operating a U.S. teaching hospital or a community hospital vs. one in Western Europe or Canada.”

Barry, I couldn’t find a comparison but a link the the Canadian Institute of Health Information (CIHI) under a search of Hospital Price Index gives a lot of information on hospital cost breakdown. Here’s the general link as most are in PDF format.

http://www.cihi.ca/CIHI-ext-portal/internet/en/Search/search/search_main_en?q=hospital%20price%20index&client=all_results&start=0&num=10&filter=0

Guest

[…] is from Jim Marks, writing at The Health Care Blog. See our previous post […]

Guest

[…] Universal access to health care does not ensure universal good health. This is the unremarkable conclusion of four Toronto researchers. Their published paper has nonetheless attracted the attention of bloggers opposed to universal health care, who cite the study with titles such as “Socialized Medicine Doesn’t Improve Health of the Poor” and “Health Insurance Doesn’t Necessarily Mean Better Health“. […]

Guest
Joel
Mar 1, 2011

errata: I meant to write that citizens should be able to choose one from at least three health plans. My apologies.

Guest
Joel
Mar 1, 2011

This study illustrates our current health care ‘system’s focus on ‘failure demand’, that is, fixing health problems after they occur instead of prevention; treatment after the fact vs meeting peoples demand for wellness. It treats health problems the way we fix cars after an accident: fix them up as best we can and put them back on the road. But unlike health care, with autos we invest money in preventing accidents.

One suggestion for reorienting the health care system from treating failures to supporting wellness is to change the way we pay for wellness: require insurance companies to be responsible for all expenses while receiving a capitation for each patient.

And if we want real competition, we can empower every citizen with the yearly opportunity to choose a standard benefit plan from three or more insurance companies. Insurance companies would compete by making people healthy or go out of business.

For single payer fans, the government could pay the capitation fee to each insurance company for each one of their registered patients. The government then would also be very interested in supporting wellness, as would citizens.

Guest
Nate Ogden
Mar 1, 2011

Oily how many do you think. I would put it at tens of thousands a year. The follow up question is would you rather die for lack of treatment but die with a house and savings. Or would you prefer to live and have to file BK but still keep your house and car and retirement?