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Heterogeneity within the Oregon Health Insurance Experiment: An application of causal forests

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  • Zaid Hattab
  • Edel Doherty
  • Andrew M Ryan
  • Stephen O’Neill

Abstract

Existing evidence regarding the effects of Medicaid expansion, largely focused on aggregate effects, suggests health insurance impacts some health, healthcare utilization, and financial hardship outcomes. In this study we apply causal forest and instrumental forest methods to data from the Oregon Health Insurance Experiment (OHIE), to explore heterogeneity in the uptake of health insurance, and in the effects of (a) lottery selection and (b) health insurance on a range of health-related outcomes. The findings of this study suggest that the impact of winning the lottery on the health insurance uptake varies among different subgroups based on age and race. In addition, the results generally coincide with findings in the literature regarding the overall effects: lottery selection (and insurance) reduces out-of-pocket spending, increases physician visits and drug prescriptions, with little (short-term) impact on the number of emergency department visits and hospital admissions. Despite this, we detect quite weak evidence of heterogeneity in the effects of the lottery and of health insurance across the outcomes considered.

Suggested Citation

  • Zaid Hattab & Edel Doherty & Andrew M Ryan & Stephen O’Neill, 2024. "Heterogeneity within the Oregon Health Insurance Experiment: An application of causal forests," PLOS ONE, Public Library of Science, vol. 19(1), pages 1-21, January.
    • Handle: RePEc:plo:pone00:0297205
    DOI: 10.1371/journal.pone.0297205
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    References listed on IDEAS

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    1. Jonathan Gruber, 2017. "Delivering Public Health Insurance through Private Plan Choice in the United States," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 3-22, Fall.
    2. Michael Geruso & Timothy J. Layton, 2017. "Selection in Health Insurance Markets and Its Policy Remedies," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 23-50, Fall.
    3. Elizabeth Stanton, 2007. "The Human Development Index: A History," Working Papers wp127, Political Economy Research Institute, University of Massachusetts at Amherst.
    4. Stéphane Verguet & Jane J. Kim & Dean T. Jamison, 2016. "Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial," PharmacoEconomics, Springer, vol. 34(9), pages 913-923, September.
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