August 12, 2011
While research consistently confirms the benefit of insurance coverage on the use of health services in the United States, few studies have simultaneously addressed the many competing unmet needs particular to unstably housed individuals. "Moreover, few have accounted for the fact that hospitalization may lead to obtaining insurance coverage, rather than the other way around," wrote the authors, who used marginal structural models to determine the longitudinal impact of insurance coverage on the uptake of health services and antiretroviral therapy (ART) among unstably housed adults living with HIV.
The impact of insurance status on the use of health services and ART was adjusted for a wide range of confounders specific to this population. The study comprised 330 participants with HIV; among them, both intermittent and continuous insurance coverage during the previous three to 12 months "had strong and positive effects on the use of ambulatory care and ART, with stronger associations for continuous insurance coverage," the team found.
The results showed that longer durations of continuous coverage were less robust in affecting emergency department and inpatient care. When confounding due to competing needs was considered in adjusted analyses, race and ethnicity had no significant influences on the use of health services by this low-income population.
"Given that ambulatory care and ART are factors with substantial potential impact on the course of HIV disease, these data suggest that securing uninterrupted insurance coverage would result in large reductions in morbidity and mortality," the authors concluded. "Health care policy efforts aimed at increasing consistent insurance coverage in vulnerable populations are warranted."