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Health Insurance Doesn’t Necessarily Mean Better Health

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.

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[…] 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: […]

Tom
Guest

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

Milena
Guest

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.

nate ogden
Guest
nate ogden

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.

Peter Q Wolfe
Guest
Peter Q Wolfe

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… Read more »

Affiliated Physicians
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.

Barry Carol
Guest
Barry Carol

“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… Read more »

Hospital_RN
Guest
Hospital_RN

Phew!

Peter
Guest
Peter

“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

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

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[…] 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“. […]

Joel
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Joel

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

Joel
Guest
Joel

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… Read more »

Nate Ogden
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Nate Ogden

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?