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Does Providing Insurance Coverage Reduce the Spread of Infectious Disease? the Impact of Medicaid Expansions on HIV Diagnoses
Does Providing Insurance Coverage Reduce the Spread of Infectious Disease? the Impact of Medicaid Expansions on HIV Diagnoses
Tuesday, June 25, 2019
Exhibit Hall C (Marriott Wardman Park Hotel)
Preventing the spread of infectious disease---a classic externality---is a textbook justification for intervention in the health care and health insurance markets. Yet little evidence exists on whether government-induced increases in insurance coverage affect the spread of infectious
disease. We study the impact of Medicaid expansions on the rate of new HIV diagnoses. We find that Medicaid expansion is associated with large increases in the use of pre-exposure prophylaxis (PrEP), a highly expensive drug regime that effectively prevents HIV acquisition. This increased use of PrEP was effective: we find that Medicaid expansion is associated with 5 percent decrease in the rate of new HIV diagnoses.
PrEP prescriptions require regular HIV testing, consistent with this we find evidence of an increase in the percent of those who were recently tested for HIV. nce-in-differences (DDD) models where the potential effect of the Medicaid expansions on outcomes varies with pre-expansion insurance and HIV prevalence levels using data from AIDSVu, Medicaid State Drug and Utilization Files, and Behavioral Risk Factor Surveillance System. The effect on health insurance on HIV incidence is ambiguous. If individuals display ex ante moral hazard and engage in more risky sex, this could increase the number of new HIV cases. Alternatively, if there were no changes in risky sex, greater access to prescription medications for both already infected (e.g. highly active antiretroviral therapy) and those susceptible to infection (e.g. pre-exposure prophylaxis – PrEP), the number of new HIV cases could decrease. The effect of insurance on STIs is also ambiguous. If individuals display ex ante moral hazard, condom use may decrease when PrEP is taken, which could increase transmission of STIs. Alternatively, if there were no behavioral changes when individuals initiate PrEP, there would be no change in STI cases. This research will inform our understanding of the impact of insurance on communicable diseases, as well as the unintended consequences, both positive and negative, of expanding health insurance.
disease. We study the impact of Medicaid expansions on the rate of new HIV diagnoses. We find that Medicaid expansion is associated with large increases in the use of pre-exposure prophylaxis (PrEP), a highly expensive drug regime that effectively prevents HIV acquisition. This increased use of PrEP was effective: we find that Medicaid expansion is associated with 5 percent decrease in the rate of new HIV diagnoses.
PrEP prescriptions require regular HIV testing, consistent with this we find evidence of an increase in the percent of those who were recently tested for HIV. nce-in-differences (DDD) models where the potential effect of the Medicaid expansions on outcomes varies with pre-expansion insurance and HIV prevalence levels using data from AIDSVu, Medicaid State Drug and Utilization Files, and Behavioral Risk Factor Surveillance System. The effect on health insurance on HIV incidence is ambiguous. If individuals display ex ante moral hazard and engage in more risky sex, this could increase the number of new HIV cases. Alternatively, if there were no changes in risky sex, greater access to prescription medications for both already infected (e.g. highly active antiretroviral therapy) and those susceptible to infection (e.g. pre-exposure prophylaxis – PrEP), the number of new HIV cases could decrease. The effect of insurance on STIs is also ambiguous. If individuals display ex ante moral hazard, condom use may decrease when PrEP is taken, which could increase transmission of STIs. Alternatively, if there were no behavioral changes when individuals initiate PrEP, there would be no change in STI cases. This research will inform our understanding of the impact of insurance on communicable diseases, as well as the unintended consequences, both positive and negative, of expanding health insurance.
