Seth A Berkowitz1,2, Rachel Gold3,4, Marisa Elena Domino2,5, Sanjay Basu6,7,8. 1. Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. 2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Center for Health Research, Kaiser Permanente, Portland, Oregon, USA. 4. Department of Research, OCHIN Inc., Portland, Oregon, USA. 5. Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA. 6. Research and Analytics, Collective Health, San Francisco, California, USA. 7. Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA. 8. School of Public Health, Imperial College London, London, UK.
Abstract
BACKGROUND: Self-employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self-employed workers, who do not have access to employer-sponsored coverage, is unclear. OBJECTIVE: To determine whether self-employment is associated with lack of health insurance coverage. DATA SOURCES: Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014-2017. STUDY DESIGN: Participants were working age (18-64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014-2017. We compared those who were employees vs those who were self-employed. Key outcomes were self-report of health insurance coverage, and of delaying needed medical care. DATA EXTRACTION METHODS: Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self-employment in year 2. PRINCIPAL FINDINGS: 16 335 individuals, representing 121 473 345 working-age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self-employment. In unadjusted analyses, 25.7% of those who became self-employed were uninsured in year 2, vs 8.1% of those who remained employees (P < .0001). In adjusted models, self-employment was associated with greater risk of being uninsured (26.1% vs 8.0%, risk difference 18.0%, 95% confidence interval [CI] 9.2% to 26.9%, P = .0001). A time-by-employment type product term suggests that 10.0 percentage points (95%CI 0.3 to 19.7 percentage points, P = .04) of the risk difference may be attributable to the change to self-employment. Self-employment was also associated with delaying needed medical care (12.0% vs 3.1%, risk difference: 8.9%, 95% CI 3.1% to 14.6%, P = .003). CONCLUSIONS: One in four self-employed workers lack health insurance coverage. Given the rise in self-employment, it is imperative to identify ways to improve health care insurance access for self-employed working-age US adults.
BACKGROUND: Self-employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self-employed workers, who do not have access to employer-sponsored coverage, is unclear. OBJECTIVE: To determine whether self-employment is associated with lack of health insurance coverage. DATA SOURCES: Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014-2017. STUDY DESIGN: Participants were working age (18-64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014-2017. We compared those who were employees vs those who were self-employed. Key outcomes were self-report of health insurance coverage, and of delaying needed medical care. DATA EXTRACTION METHODS: Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self-employment in year 2. PRINCIPAL FINDINGS: 16 335 individuals, representing 121 473 345 working-age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self-employment. In unadjusted analyses, 25.7% of those who became self-employed were uninsured in year 2, vs 8.1% of those who remained employees (P < .0001). In adjusted models, self-employment was associated with greater risk of being uninsured (26.1% vs 8.0%, risk difference 18.0%, 95% confidence interval [CI] 9.2% to 26.9%, P = .0001). A time-by-employment type product term suggests that 10.0 percentage points (95%CI 0.3 to 19.7 percentage points, P = .04) of the risk difference may be attributable to the change to self-employment. Self-employment was also associated with delaying needed medical care (12.0% vs 3.1%, risk difference: 8.9%, 95% CI 3.1% to 14.6%, P = .003). CONCLUSIONS: One in four self-employed workers lack health insurance coverage. Given the rise in self-employment, it is imperative to identify ways to improve health care insurance access for self-employed working-age US adults.
Authors: Benjamin D Sommers; Rebecca Gourevitch; Bethany Maylone; Robert J Blendon; Arnold M Epstein Journal: Health Aff (Millwood) Date: 2016-10-01 Impact factor: 6.301
Authors: Jean P O'Malley; Maureen O'Keeffe-Rosetti; Robert A Lowe; Heather Angier; Rachel Gold; Miguel Marino; Brigit Hatch; Megan Hoopes; Steffani R Bailey; John Heintzman; Charles Gallia; Jennifer E DeVoe Journal: Med Care Date: 2016-11 Impact factor: 2.983