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Insurance and the Utilization of Medical Services Among the Self-Employed

Author

Listed:
  • Craig William Perry
  • Harvey S. Rosen
Abstract
There has been substantial public policy concern over the relatively low rates of health insurance coverage among the self-employed in the United States. We use data from the Medical Expenditure Panel Survey conducted in 1996 to analyze how the self-employed and wage-earners differ both with respect to insurance coverage and utilization of a variety of health care services. Our results suggest that for the self-employed, the link between insurance and utilization of health care services is not as strong as assumed in the policy debate. For a number of medical care services, the self-employed have the same rates of utilization as wage-earners, despite the fact that they are substantially less likely to be insured. And when the self-employed are less likely than wage-earners to utilize a particular medical service, the differences generally do not seem very large. The self-employed thus appear to be able to finance access to health care from sources other than insurance. Further, analysis of out-of-pocket expenditures on health care suggests that doing so does not lead to substantial reductions in their ability to consume other goods and services. Finally, there is no evidence that children of the self-employed have less access to health care than the children of wage-earners. Hence, the public policy concerns that the relative lack of health insurance among the self-employed substantially reduces utilization of health care services or creates economic hardship appear to be misplaced.

Suggested Citation

  • Craig William Perry & Harvey S. Rosen, 2001. "Insurance and the Utilization of Medical Services Among the Self-Employed," NBER Working Papers 8490, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:8490
    Note: EH PE
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    References listed on IDEAS

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    1. Melissa A. Thomasson, 2003. "The Importance of Group Coverage: How Tax Policy Shaped U.S. Health Insurance," American Economic Review, American Economic Association, vol. 93(4), pages 1373-1384, September.
    2. Angus S. Deaton & Christina Paxson, 2001. "Mortality, Education, Income, and Inequality among American Cohorts," NBER Chapters, in: Themes in the Economics of Aging, pages 129-170, National Bureau of Economic Research, Inc.
    3. Feldstein, Martin, 1995. "The Economics of Health and Health Care: What Have We Learned? What Have I Learned?," American Economic Review, American Economic Association, vol. 85(2), pages 28-31, May.
    4. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    5. Ettner, Susan L., 1996. "New evidence on the relationship between income and health," Journal of Health Economics, Elsevier, vol. 15(1), pages 67-85, February.
    6. Paul Taubman & Sherwin Rosen, 1982. "Healthiness, Education, and Marital Status," NBER Chapters, in: Economic Aspects of Health, pages 121-140, National Bureau of Economic Research, Inc.
    7. Marquis, M. Susan & Long, Stephen H., 1995. "Worker demand for health insurance in the non-group market," Journal of Health Economics, Elsevier, vol. 14(1), pages 47-63, May.
    8. Jonathan Gruber & James M. Poterba, 1993. "Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed," NBER Working Papers 4435, National Bureau of Economic Research, Inc.
    9. Darius Lakdawalla & Tomas Philipson, 2002. "The Rise in Old-Age Longevity and the Market for Long-Term Care," American Economic Review, American Economic Association, vol. 92(1), pages 295-306, March.
    10. Hurd, Michael D. & McGarry, Kathleen, 1997. "Medical insurance and the use of health care services by the elderly," Journal of Health Economics, Elsevier, vol. 16(2), pages 129-154, April.
    11. Jonathan S. Skinner & John Wennberg, 2000. "How Much Is Enough? Efficiency and Medicare Spending in the Last Six Months of Life," NBER Chapters, in: The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit Institutions, pages 169-194, National Bureau of Economic Research, Inc.
    12. Holtz-Eakin, Douglas & Penrod, John R. & Rosen, Harvey S., 1996. "Health insurance and the supply of entrepreneurs," Journal of Public Economics, Elsevier, vol. 62(1-2), pages 209-235, October.
    13. Donna B. Gilleskie, 1998. "A Dynamic Stochastic Model of Medical Care Use and Work Absence," Econometrica, Econometric Society, vol. 66(1), pages 1-46, January.
    14. Coate, Stephen, 1995. "Altruism, the Samaritan's Dilemma, and Government Transfer Policy," American Economic Review, American Economic Association, vol. 85(1), pages 46-57, March.
    15. Mark Stabile, 2001. "Private insurance subsidies and public health care markets: evidence from Canada," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 34(4), pages 921-942, November.
    16. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
    17. Jonathan Gruber & James Poterba, 1994. "Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 109(3), pages 701-733.
    18. repec:pri:cheawb:deaton_paxson_mortality_cohorts is not listed on IDEAS
    19. Barton H. Hamilton, 2000. "Does Entrepreneurship Pay? An Empirical Analysis of the Returns to Self-Employment," Journal of Political Economy, University of Chicago Press, vol. 108(3), pages 604-631, June.
    20. Craig W. Perry & Harvey S. Rosen, 2001. "The Self-Employed Are Less Likely To Have Health Insurance Than Wage Earners: So What?," Working Papers 129, Princeton University, Department of Economics, Center for Economic Policy Studies..
    21. repec:pri:cepsud:71rosen is not listed on IDEAS
    22. Robert Kaestner & Theodore Joyce & Andrew Racine, 1999. "Does Publicly Provided Health Insurance Improve the Health of Low-Income Children in the United States," NBER Working Papers 6887, National Bureau of Economic Research, Inc.
    23. repec:pri:cheawb:deaton_paxson_mortality_cohorts.pdf is not listed on IDEAS
    24. Victor R. Fuchs, 2005. "Health, Government, and Irving Fisher," American Journal of Economics and Sociology, Wiley Blackwell, vol. 64(1), pages 407-425, January.
    25. Jonathan S. Skinner & Elliott S. Fisher & John Wennberg, 2005. "The Efficiency of Medicare," NBER Chapters, in: Analyses in the Economics of Aging, pages 129-160, National Bureau of Economic Research, Inc.
    26. Campling, R.F., 1987. "Employee Benefits and the Part-Time Worker," Papers 13, Queen's at Kingston - Sch. of Indus. Relat. Research Essay Series.
    27. Craig William Perry & Harvey S. Rosen, 2001. "The Self-Employed are Less Likely to Have Health Insurance Than Wage Earners. So What?," NBER Working Papers 8316, National Bureau of Economic Research, Inc.
    28. Craig W. Perry & Harvey S. Rosen, 2001. "The Self-Employed Are Less Likely To Have Health Insurance Than Wage Earners: So What?," Working Papers 129, Princeton University, Department of Economics, Center for Economic Policy Studies..
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    Cited by:

    1. Kelly D. Edmiston, 2007. "The role of small and large businesses in economic development," Economic Review, Federal Reserve Bank of Kansas City, vol. 92(Q II), pages 73-97.
    2. Meer, Jonathan & Rosen, Harvey S., 2004. "Insurance and the utilization of medical services," Social Science & Medicine, Elsevier, vol. 58(9), pages 1623-1632, May.
    3. Craig William Perry & Harvey S. Rosen, 2001. "The Self-Employed are Less Likely to Have Health Insurance Than Wage Earners. So What?," NBER Working Papers 8316, National Bureau of Economic Research, Inc.
    4. Kuo-Liang Chang & George Langelett & Andrew Waugh, 2011. "Health, Health Insurance, and Decision to Exit from Farming," Journal of Family and Economic Issues, Springer, vol. 32(2), pages 356-372, June.
    5. David Zimmer, 2009. "Insurance Arrangements Among Married Couples: Analysis of Benefit Substitution and Compensating Differentials," Journal of Family and Economic Issues, Springer, vol. 30(4), pages 428-439, December.
    6. repec:pri:cepsud:85rosen is not listed on IDEAS
    7. David Zimmer, 2010. "Health Insurance and Health Care Demand Among the Self-employed," Journal of Labor Research, Springer, vol. 31(1), pages 1-19, March.
    8. Kelly D. Edmiston, 2004. "The role of small business in economic development," Community Affairs Research Working Paper 2005-01, Federal Reserve Bank of Kansas City.
    9. Ahearn, Mary Clare & El-Osta, Hisham & Mishra, Ashok K., 2013. "Considerations in Work Choices of U.S. Farm Households: The Role of Health Insurance," Journal of Agricultural and Resource Economics, Western Agricultural Economics Association, vol. 38(1), pages 1-15, April.

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    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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