Problem drinking as intentional risky behavior: Examining the association between state health insurance coverage and excessive alcohol consumption

Abstract

The moral hazard theory asserts that having health insurance may increase individual risk-taking behaviors. We examined the association between state health insurance coverage and excessive alcohol use among U.S. adults. We used 2001–2017 Behavioral Risk Factor Surveillance System data to estimate annual binge and heavy drinking rates for each state. In a multivariable regression analysis, we used difference-in-difference (DID) models to assess the association between state-level insurance coverage and binge and heavy drinking. Additionally, we assess the potential asymmetric effect and whether economic recessions (2001, 2008–09) had a moderation effect. In the multivariable DID analysis, aggregate state insurance coverage was not significantly associated with binge drinking rates in baseline analysis with state-fixed effects (Model 1), and in the analysis that extends the baseline model to include state unique time trend (Model 2). A similar result was found for heavy drinking in Model 1. In contrast, the result showed a significant association between health insurance coverage and heavy drinking rates in Model 2. However, we found no significant association for binge and heavy drinking rates in both models in the analyses restricting data to periods before the methodological change in the BRFSS sampling frame. The results did not show asymmetric effects, and the association between health insurance and excessive alcohol use did not differ during economic recessions. These findings largely do not support assertions that health insurance may lead to moral hazards (risk-taking behaviors), especially binge drinking

Does state repeal of alcohol exclusion laws increase problem drinking?

“…First, a central underpinning of AELs rests on them functioning as a deterrent to moral hazard (i.e., increased propensity for risk‐taking behaviors due to having some form of protection such as health insurance policy coverage) (Ehrlich & Becker, 1972 ). There is inconclusive evidence supporting moral hazard more generally in the health insurance context (Azagba et al, 2021 ; Barbaresco et al, 2015 ; Dave & Kaestner, 2009 ; Dong, 2013 ; Khwaja, 2010 ). Second, the primary purpose of the AELs in statutes was not to permit these clauses but instead to specify that, when they are used, they should have certain forms and content, and in practice, restrictions on applying alcohol exclusion provisions varied across states.…”

COVID-19 and Latinx alcohol use: The role of health insurance.

“…However, minimal research has explored the relationship between COVID-19-related stressors, health insurance, and alcohol use within the Latinx community. While some research exists examining the impact of health insurance on alcohol consumption, seemingly no previous empirical literature has explored health insurance as a moderator for emotional/physical health and alcohol use (Azagba et al, 2021; Yu et al, 2022). The present study offers a novel approach to assessing the role of having health insurance in health outcomes and alcohol use.…”

Psychological discomfort and binge drinking in Mexican adults

“…A set of variables associated with psychological discomfort and/or binge drinking were included: sex (men = 1, women = 0) (7), place of residence (urban = 1, rural = 0) (3), marital status (married = 1, unmarried = 0), 29 employment status (employed = 1, unemployed= 0). 30 We included health insurance (yes = 1, no = 0), 31 religion (catholic = 1, other = 0), 32 age at drinking onset (< 20 years old = 1, > 20 years old= 0). 33 For educational level three binary variable were created: elementary, middle school and high school education or higher, where the variables were: 1 if it was related to the last study level of the participant and 0 if not.…”