Insurance and the utilization of medical services
AbstractMost data sets indicate a positive correlation between having health insurance and utilizing health care services. Yet the direction of causality is not at all clear. If we observe a positive correlation between the utilization of health care services and insurance status, we do not know if this is because people who anticipate poor health buy more insurance (or take jobs with generous medical coverage), or because insurance lowers the cost of health care, increasing the quantity demanded. While a few attempts have been made to implement an instrumental variables (IV) strategy to deal with endogeneity, the instruments chosen have not been entirely convincing. In this paper we revisit the IV estimation of the reduced form relationships between insurance and health care utilization taking advantage of what we argue is a good instrument--the individual's self-employment status. Our main finding is that a positive and statistically significant effect of insurance continues to obtain even after instrumenting. Indeed, instrumental variables estimates of the impact of insurance on utilization of a variety of health care services are larger than their non-instrumented counterparts. The validity of this exercise depends on the extent to which self-employment status is a suitable instrument. To argue this case, we analyze panel data on transitions from wage-earning into self-employment and show that individuals who select into self-employment do not differ systematically from those who remain wage-earners with respect to either the utilization of health care or health status. While this finding does not prove that self-employment status is an appropriate instrument, it is encouraging that there appear to be no underlying differences that might lead to self-employment per se affecting health services utilization.
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Bibliographic InfoArticle provided by Elsevier in its journal Social Science & Medicine.
Volume (Year): 58 (2004)
Issue (Month): 9 (May)
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Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description
Other versions of this item:
- I1 - Health, Education, and Welfare - - Health
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- John Bound & David A. Jaeger & Regina Baker, 1993. "The Cure Can Be Worse than the Disease: A Cautionary Tale Regarding Instrumental Variables," NBER Technical Working Papers 0137, National Bureau of Economic Research, Inc.
- Craig William Perry & Harvey Rosen, 2001.
"Insurance and the Utilization of Medical Services Among the Self-Employed,"
CESifo Working Paper Series
580, CESifo Group Munich.
- 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.
- Douglas Holtz-Eakin & John R. Penrod & Harvey S. Rosen, 1994.
"Health Insurance and the Supply of Entrepreneurs,"
NBER Working Papers
4880, National Bureau of Economic Research, Inc.
- repec:pri:cepsud:117 is not listed on IDEAS
- Jonathan Gruber & Brigitte C. Madrian, 2002.
"Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature,"
NBER Working Papers
8817, National Bureau of Economic Research, Inc.
- Jonathan Gruber & Brigitte C. Madrian, 2002. "Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature," JCPR Working Papers 255, Northwestern University/University of Chicago Joint Center for Poverty Research.
- Melissa A. Thomasson, 2000.
"The Importance of Group Coverage: How Tax Policy Shaped U.S. Health Insurance,"
NBER Working Papers
7543, National Bureau of Economic Research, Inc.
- 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.
- Smith, James P, 1998. "Socioeconomic Status and Health," American Economic Review, American Economic Association, vol. 88(2), pages 192-96, May.
- James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
- John Cawley, 2000. "Body Weight and Women's Labor Market Outcomes," NBER Working Papers 7841, National Bureau of Economic Research, Inc.
- Rivers, Douglas & Vuong, Quang H., 1988. "Limited information estimators and exogeneity tests for simultaneous probit models," Journal of Econometrics, Elsevier, vol. 39(3), pages 347-366, November.
- Dan Shane; & Pravin Trivedi;, 2012. "What Drives Differences in Health Care Demand? The Role of Health Insurance and Selection Bias," Health, Econometrics and Data Group (HEDG) Working Papers 12/09, HEDG, c/o Department of Economics, University of York.
- Jonneke Bolhaar & Maarten Lindeboom & Bas van der Klaauw, 0000.
"A Dynamic Analysis of the Demand for Health Insurance and Health Care,"
Tinbergen Institute Discussion Papers
08-084/3, Tinbergen Institute.
- Bolhaar, Jonneke & Lindeboom, Maarten & van der Klaauw, Bas, 2012. "A dynamic analysis of the demand for health insurance and health care," European Economic Review, Elsevier, vol. 56(4), pages 669-690.
- Bolhaar, Jonneke & Lindeboom, Maarten & van der Klaauw, Bas, 2008. "A Dynamic Analysis of the Demand for Health Insurance and Health Care," CEPR Discussion Papers 6968, C.E.P.R. Discussion Papers.
- Bolhaar, Jonneke & Lindeboom, Maarten & van der Klaauw, Bas, 2008. "A Dynamic Analysis of the Demand for Health Insurance and Health Care," IZA Discussion Papers 3698, Institute for the Study of Labor (IZA).
- Denzil Fiebig & Elizabeth Savage & Rosalie Viney, 2006. "Does the reason for buying health insurance influence behaviour? CHERE Working Paper 2006/1," Working Papers 2006/1, CHERE, University of Technology, Sydney.
- José A. Pagán & Andrea Puig & Beth J. Soldo, 2007. "Health insurance coverage and the use of preventive services by Mexican adults," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1359-1369.
- Jonneke Bolhaar & Maarten Lindeboom & Bas van der Klaauw, 0000. "A Dynamic Analysis of the Demand for Health Insurance and Health Care," Tinbergen Institute Discussion Papers 08-084/3, Tinbergen Institute.
- repec:ilo:ilowps:375955 is not listed on IDEAS
- Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
- Partha Deb & Chenghui Li & Pravin K. Trivedi & David M. Zimmer, 2006. "The effect of managed care on use of health care services: results from two contemporaneous household surveys," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 743-760.
- repec:dgr:uvatin:0000084 is not listed on IDEAS
- Hendrik P. van Dalen, 2006. "When Health Care Insurance does not make a Difference – The Case of Health Care ‘Made in China’," Tinbergen Institute Discussion Papers 06-091/1, Tinbergen Institute.
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