Abstract
Neighborhood characteristics may moderate the effects of Medicaid coverage on health outcomes. Identifying this interplay can inform the design, targeting, and implementation of health policy. We combine data from the Oregon Health Insurance Experiment, which randomized access to Medicaid, with rich new data on multiple domains of neighborhood characteristics to assess the interaction between the local environment and the effect of insurance on health. Overall, we do not find that neighborhood characteristics substantially affect the relationship between gaining insurance and health outcomes, suggesting that Medicaid expansions are similarly effective across neighborhoods. This analysis highlights the complex relationship between health insurance coverage, neighborhood characteristics, and health.
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Acknowledgements
We are indebted to Bill J. Wright for data collection, support, and expertise, which were critical to this study, and we are grateful to the survey research team at CORE. We are also grateful to several anonymous reviewers for their helpful comments and suggestions, and to Haidong Lu for his statistical insights. Julia Dennett is additionally indebted to her advisors, David Cutler, Katherine Baicker, Thomas McGuire, and Ateev Mehrotra. We gratefully acknowledge funding for the Oregon Health Insurance Experiment from the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services; the California HealthCare Foundation; the John D. and Catherine T. MacArthur Foundation; the National Institute on Aging (P30AG012810, RC2AGO36631, and R01AG0345151); the Robert Wood Johnson Foundation; the Alfred P. Sloan Foundation; the Smith Richardson Foundation; and the Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration); and by the Centers for Medicare and Medicaid Services. Julia Dennett acknowledges support from the National Science Foundation Graduate Research Fellowship Program (DGE1144152), the Agency for Healthcare Research and Quality (T32HS000055), the National Institute on Aging, Grant Number T32-AG000186, and a Harvard University GSAS Dissertation Completion Fellowship. The findings and conclusions expressed are solely those of the authors and do not represent the views of SSA, the National Institute on Aging, the National Institutes of Health, the Agency for Healthcare Research and Quality, the National Science Foundation, any agency of the Federal Government, any of our funders, or the NBER.
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Dennett, J.M., Baicker, K. Medicaid, Health, and the Moderating Role of Neighborhood Characteristics. J Urban Health 99, 116–133 (2022). https://doi.org/10.1007/s11524-021-00579-2
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DOI: https://doi.org/10.1007/s11524-021-00579-2