中文摘要
为回应人们对糖尿病日益增长的担忧，自20世纪90年代末以来，各州强制规定医疗保险提供糖尿病保障待遇的做法日益普遍。然而，人们对这些强制规定是否改善了糖尿病患者的健康状况仍知之甚少。本文使用受限的多重死因死亡数据库及行为危险因素监测系统的数据，考察这些强制规定对糖尿病相关死亡率的影响，以及估计效应背后的作用机制。我采用双重差分框架，利用各州之间及不同时期强制规定颁布情况的差异，发现实施强制规定的州每年每10万人中的糖尿病相关死亡人数，比未实施强制规定的州约少3.1人。机制分析提示，这些死亡率的改善是由强制规定所涵盖的医疗保障待遇利用增加所致。这些发现可为当前关于加强或削弱强制保障规定的政策讨论提供参考，其中包括《平价医疗法案》下的基本健康福利相关规定。
Abstract
In response to the growing concern over diabetes, state-mandated health insurance benefits for diabetes have become popular since the late 1990s. However, little is known about whether these mandates improve the health of people with diabetes. In this paper, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of these mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act.