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Self-employment, health, and health care: When the going gets tough, the tough get going?

Author

Listed:
  • Clémentine Garrouste

    (Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LEDA-LEGOS - Laboratoire d’Economie et de Gestion des Organisations de Santé - LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique)

  • Alain Paraponaris

    (AMU - Aix Marseille Université, EHESS - École des hautes études en sciences sociales, ECM - École Centrale de Marseille, AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

  • Nicolas Sirven

    (UR - Université de Rennes, ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique, IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

Abstract

This study provides a life-course analysis of the relationship between self-employment, health, and health care use among individuals aged 50 and older in Europe. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we apply first-difference and dynamic panel data models that go beyond standard approaches in mitigating endogeneity concerns. Our findings show that the self-employed enjoy better health at younger ages, consistent with a selection effect. In addition, they experience a steeper decline in physical health over time. We also document two distinct phases of health care use: during working life, the self-employed are more likely to be hospitalised, suggesting delayed care until acute needs arise; after retirement, the number of medical visits increases, consistent with a lower opportunity cost of care.

Suggested Citation

  • Clémentine Garrouste & Alain Paraponaris & Nicolas Sirven, 2026. "Self-employment, health, and health care: When the going gets tough, the tough get going?," Post-Print hal-05446054, HAL.
    • Handle: RePEc:hal:journl:hal-05446054
    DOI: 10.1016/j.ehb.2025.101567
    as

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