Health Rankings and Health Insurance

Following Dan’s recent post regarding health rankings, commenter Rachel Marshall wondered whether there was a relationship between health rankings and insurance availability. Well, you ask; we (sometimes) provide.

The chart below plots the health rankings used in Dan’s post against each state’s uninsurance rate; that is, the percentage of residents without health insurance. States won by Obama are plotted in blue; those won by McCain, in red.

Ranking Sources: America’s Health RankingUninsurance rates

Some commentary and analysis follows, below the fold.

First, note that there seems to be a fairly strong correlation between high uninsurance rates and poor health ranking. Most of the data points fall either within the upper right quadrant, where states have above average uninsurance rates and poorer than average health ranks, or within the lower left quadrant, where states have below average uninsurance rates and better than average health ranks. I need to point out one important caveat: uninsurance rates are a component of the health index, so we would naturally expect some correlation. It is only one of several components, however, and is weighted to account for only 5 percent of the score behind the health rankings, so I’ll press on.

So, does that mean that lack of insurance leads to poor health? Probably in part, but be careful about drawing to strong an inference from a simple correlation like this. For one thing, only 25 percent of the health ranking score is based on health outcomes; the other 75 percent is based on socioeconomic or policy variables (like obesity prevalence or uninsurance rates) that tend to be correlated with health outcomes. It is likely that states with poor health rank scores and high uninsurance rates may have other similar characteristics, such as lower incomes and education levels, that can lead to both poor health and lack of insurance. To determine causality requires a more sophisticated analysis.

Harvard medical researchers have conducted such a study and found that:

uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity. It estimated that lack of health insurance causes 44,789 excess deaths annually.

Based on their research, I think it is safe to say that there is a strong causal relationship between uninsurance and poor health.

Next, note that a bit more than half of the states in the top half of the plot are red and somewhat more than half of the states in the bottom half are blue. Does this mean that Republicans are less healthy than Democrats. Not necessarily. Remember, a large part of the health rank scores are based on socioeconomic and policy variables. I think it is likely that underlying cultural differences across states can be related both to these variables and to voters’ tendencies to vote Democratic or Republican.

Finally, note that red states comprise over half the states in the right half of the plot, where uninsurance rates are high. They make up less than a third of the states in the left half, where uninsurance rates are low. Recall that red state congress members tended to oppose the house health care bill. Does this mean that GOP congress members from red states are voting against their constituents’ interests?

Some might make that claim. I won’t go that far. If you feel strongly that legislators should act as trustees, voting in the best interests of their constituents even if the vote goes against their wishes, then maybe. If on the other hand, legislators act as delegates, voting according to their constituents’ desires, even if the vote is against their interests, then maybe the vote reflects the cultural differences I mentioned earlier. Perhaps red state voters prefer less government involvement in health care, even if they would benefit from wider availability of health insurance.



One Response

  1. Well done Dr. Taylor!

    Health Status is a function of many different things and is very hard to make very broad statements of correlation. However, many studies show that higher educated people are more healthy as well! The reasons are many, but it illustrates the multifaceted nature of the issue!

    Lets look at the uninsurance rate specifically.

    For instance, competition among plans can be very important! If you look at a popular AMA report called “Competition in Health Insurance: A Comprehensive Study of U.S. Markets”, you can see the competition by state and market!

    Larger markets typically have more competition, its much harder for insurers to provide insurance to rural regions etc. In Indiana alone two companies dominate 75% of the market. If you look at specific region it can differ as well. For instance, Gary and Anderson have little competition with two companies commanding 92% and 87% of the market!

    Uninsurance can be caused by source as well. Maybe the higher uninsurance rates are caused by the fact that many people might have to find a plan in an individual market. That is, where somebody doesn’t have access to an employer plan and doesn’t qualify for one of the government health services.

    Individual market insurance is really expensive. Moreover, the premiums, again depending on locality, can fluctuate a lot! Small employers and individual markets are especially effected by this factor.

    I could go on and on, but the uninsurance rate is such a complex number in itself, it is such a hard field to study!

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