Research Spotlight: Does public insurance provide better care?

Manan Roy

Research Spotlight: Does public insurance provide better care?

In the fierce national debate over a new federal law that requires all Americans to have health insurance, it’s widely assumed that private health insurance can do a better job than the public insurance funded by the U.S. government.

But a first-of-its-kind analysis of newly available government data found just the opposite when it comes to infants covered by insurance.

Among the insured, infants in low-income families are better off under the nation’s government-funded public health insurance than infants covered by private insurance, says SMU economist Manan Roy, the study’s author.

The finding is surprising, says Roy, because the popular belief is that private health insurance always provides better coverage. Roy’s analysis, however, found public health insurance is a better option — and not only for low-income infants.

“Public health insurance gets a lot of bad press,” says Roy. “But for infants who are covered by health insurance, the government-funded insurance appears to be more efficient than private health insurance — and can actually provide better care at a lower cost.

“Private health insurance plans vary widely,” Roy says. “Many don’t include basic services. So infants on more affordable plans may not be covered for immunizations, prescription drugs, for vision or dental care, or even basic preventive care.”

The U.S. doesn’t have a system of universal health insurance. But the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010, requires all Americans to have health insurance. The act also expands government-paid free or low-cost Medicaid insurance to 133 percent of the federal poverty level.

SMU Ph.D. candidate and Adjunct Professor of Economics Manan Roy

“Given the study’s surprising outcome, it’s likely that the impact of national reforms to bring more children under public health insurance will substantially improve the health of infants who are in the worst health to begin with,” says Roy (pictured right). “It’s likely to also help infants who aren’t low-income.”

Roy presented her study, “How Well Does the U.S. Government Provide Health Insurance?” at the 2011 Western Economic Association International conference in San Diego. She is a Ph.D. student and an adjunct professor of economics in SMU’s Dedman College of Humanities and Sciences.

A large body of previous research has established that insured infants are healthier than uninsured infants. Roy’s study appears to be the first of its kind to look only at insured infants to determine which kind of insurance has the most impact on infant health — private or public.

Roy found:

  • Infants covered by public insurance are mostly from disadvantaged backgrounds. Those under Medicaid and its sister program — CHIP — come mostly from lower-income families. Their parents — usually black and Hispanic — are more likely to be unmarried, younger and less educated. Economists refer to this statistical phenomenon — when a group consists primarily of people with specific characteristics — as strong positive or negative selection. In the case of public health insurance, strong negative selection is at work because it draws people who are poor and disadvantaged.
  • Infants on public health insurance are slightly less healthy than infants on private insurance. On average they had a lower five-minute Apgar score and shorter gestation age compared to privately insured infants. They were less likely to have a normal birth weight and normal Apgar score range, and were less likely to be born near term.
  • Infants covered by private health insurance are mostly from white or Asian families and are generally more advantaged. They are from higher-income families, with older parents who are usually married and more educated. Their mothers weigh less than those of infants on public insurance. This demonstrates strong positive selection of wealthier families into private health insurance.
  • Roy then compared the effect of public insurance on infant health in relation to private health insurance. To do that, she used an established statistical methodology that allows economists to factor negative or positive selection into the type of insurance. In comparing public vs. private insurance — allowing for strong negative selection into public health care — a different picture emerged.

“The results showed that it’s possible to attribute the entire detrimental effect of public health insurance to the negative selection that draws less healthy infants into public health insurance,” Roy says.

Written by Margaret Allen

> Read the full story at the SMU Research blog

January 26, 2012|Research|

Data-mining champions bring title to SMU

SMU's Data Mining Shootout championsThree SMU graduate students in Dedman College of Humanities and Sciences have been named the nation’s best at sorting and comparing vast amounts of computer data. Economics Ph.D. candidates Stefan Avdjiev, Jayjit Roy and Manan Roy won the 2008 Data Mining Shootout and its $5,000 prize based on their program logic and software solutions for a fictional airline trying to improve customer satisfaction with company responses to weather events.

More than 30 teams from universities and colleges across the country competed in the competition. SMU’s winning team was announced at a conference at Caesar’s Palace in Las Vegas. It was the University’s first time to enter the competition, said faculty sponsor and economics professor Tom Fomby. “We were not only the newcomers,” Fomby said. “We were the winners.”

(Right, SMU President R. Gerald Turner, Jayjit Roy, Manan Roy, Stefan Avdjiev and Professor Tom Fomby. Photograph by Hillsman S. Jackson.)

Read more from SMU News.

November 7, 2008|News|

For the Record: Oct. 30, 2008

Karen Vickery, Learning Therapy, has received a 2008 IMSLEC Innovator Award for Outstanding Educator in a University from the International Multisensory Structured Language Education Council. She was recognized at the IMSLEC Council meeting during the International Dyslexia Association conference Oct. 29, 2008, in Seattle.

Three SMU graduate students in Economics are the No. 1 data-mining team in the nation, as announced by the 2008 Data Mining Shootout sponsored by the SAS Institute, Dow Chemical Company and the Central Michigan University Research Corporation. Ph.D. candidates Stefan Avdjiev, Jayjit Roy and Manan Roy won the competition based on their program logic and software solutions to a complex scheduling problem involving a hypothetical airline company operating at three airports and anticipating weather delays and cancellations. Tom Fomby is their faculty sponsor and adviser.

October 30, 2008|For the Record|

For the Record: Sept. 5, 2008

Museum depiction of NeanderthalMetin Eren, a graduate student in experimental archaeology, has done a study slated for publication in The Journal of Human Evolution that uses data on how early humans made tools to determine that Neanderthals were smarter than previously believed. Garth Sampson, Anthropology (Emeritus), is Eren’s co-author (along with Aaron Greenspan of Think Computer Corporation) on the paper, titled “Are Upper Paleolithic blade cores more productive than Middle Paleolithic discoidal cores? A replication experiment” (PDF). Read more and find more media coverage at SMU News.

Anthony Cortese, Sociology, presented a paper, “Racial Profiling and Ethnic Stereotyping: Muslim Terrorists and Illegal Aliens,” at a Racial Profiling on Borders conference in Vancouver, British Columbia.

Three SMU graduate students in Economics make up one of three finalist teams in the 2008 Data Mining Shootout sponsored by the SAS Institute, Dow Chemical Company and the Central Michigan University Research Corporation. Ph.D. candidates Stefan Avdjiev, Jayjit Roy and Manan Roy made the top three based on their program logic and software solutions to a complex scheduling problem involving a hypothetical airline company operating at three airports and anticipating weather delays and cancellations.

The team will travel to the 11th Annual SAS Data Mining Conference in Las Vegas Oct. 27-28 for the announcement of the final finish order. Tom Fomby is their faculty sponsor and adviser.

September 5, 2008|For the Record|
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