Association for Public Policy Analysis & Management

Violence injuries are one of the leading causes of death for individuals younger than 45. However, most victims physically injured by violence do not receive medical care, and among those who do, less than half visit a healthcare provider. Victims’ healthcare decisions have direct implications for the fallout of violence on individuals and communities. For individuals, violence may lead to psychological trauma, physical complications, re-injury, and even death when healthcare is never received or received too late. When violence becomes lethal, it can have an emotional and financial ripple effect by introducing secondary trauma to loved ones and economic costs to communities through lost productivity. Thus, understanding the mutable, policy-relevant factors in victims’ healthcare outcomes is important for practitioners interested in ameliorating the deleterious consequences of violence.

Prior research indicates that medical insurance is one of the most important factors in people’s healthcare decisions. After the adoption of the 2010 Affordable Care Act (ACA), the uninsured rate in the United States population significantly decreased, and the Obama Administration claimed that this policy offered a “lifeline” to violence victims because it increased their access to affordable health insurance and healthcare services.

However, no study has examined the effect of medical insurance on violence victims' healthcare decisions. Consequently, it is uncertain how or whether medical insurance influences the healthcare decisions of violence victims, who vary substantially in the acuteness of their injuries and their medical need. On the one hand, medical insurance may increase all violence victims’ healthcare use because medical insurance reduces the cost and subsequently increases the consumption of healthcare services. On the other hand, the effect of medical insurance on violence victims’ healthcare use may differ depending on the severity of their injuries, as medical need has been found to amplify but also mute the cost-saving benefits of medical insurance that encourage healthcare consumption.

This study uses data from the National Crime Victimization Survey to (a) examine the effect of medical insurance on violence victims’ healthcare use and (b) test whether victims’ level of injury moderates the effect of medical insurance on their healthcare use. Propensity score matching analyses of the insurance effect revealed that insured violence victims were 18.7% more likely than uninsured violence victims to use healthcare services. Among victims with minor injuries, medical insurance increased the likelihood of healthcare use by 27.7%. Among victims with severe injuries, by contrast, medical insurance increased the likelihood of healthcare use by only 11.7%. A Clogg test of the equality of the insurance effect sizes across injury samples indicated that the medical insurance effect did not significantly differ by the medical need of victims. Even when violence injuries were severe and potentially life threatening, the financial costs of healthcare still deterred violence victims from seeking treatment. These findings have significant implications for the capacity of medical insurance to encourage healthcare utilization among violence victims and to ameliorate the harm of violence in the population.