Vice president Al Gore's health care agenda and the utilization of medical services: An empirical analysis.
OBJECTIVE
To estimate the impact of Vice President Al Gore's healthcare agenda on the utilization of physician and hospital services among 4 uninsured target populations: parents of publicly insured children; near elderly adults, ages 55-64; employed adults with disabilities; and adults employed in small firms or self-employed.


METHODS
From the 1993 National Health Interview Survey, we select 4 representative samples of uninsured adults, ages 18-64, corresponding to the target groups described in Gore's healthcare agenda. For each adult in these samples, we estimate the change in medical service utilization caused by becoming insured using results from Craig and Ko.[1] The weighted average of these estimates represents the expected change in medical service utilization attributable to insurance.


RESULTS
The increase in the utilization caused by insurance depends on the target group and the service in question. The increase in utilization of physician visits is 16% among parents of publicly insured children, 37% among the near elderly, 8% among the employed, disabled adults, and 21% among the self-employed. This effect is small compared with the increase in surgical procedures (31%, 110%, 316%, and 101%, respectively). However, given the size of the US healthcare system, this amounts to about a 0.5% increase in the production of medical services. Even if a universal coverage plan were instated in place of Gore's incremental coverage plan, production would increase by about 2%.


CONCLUSIONS
Points 2 through 5 of Vice President Al Gore's healthcare agenda have an impact on the utilization of medical care by the 4 target populations. However, this impact varies by service and population, and its system-wide impact on the production of care is minor.
Craig
B M
BM
University of Wisconsin, Madison, 53705, USA.
Koç
C
C
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000331:legislation & jurisprudence* / Q000639:trends; D010820:Physicians / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data; D011057:Politics; D014481:United States / Q000453:epidemiology