Staying Well

No insurance, no health care?


It's long been assumed that the 44.2 million Americans who don't have health insurance aren't getting health care. A recent study from the National Bureau of Economic Research casts doubt on this correlation, at least among those who are self-employed.

Princeton economists Craig William Perry and Harvey S. Rosen looked at a sample of 9,552 people, of whom 1,158 (12 percent) were self-employed. In their sample, only 68 percent of the self-employed were insured, compared to 81 percent of the wage-earners. Despite that difference in insurance, they found little significant difference in actual health care use between the two groups.

Contrary to the assumption that no insurance equals no health care use, there was no significant difference between the self-employed and wage-earners when it came to many measures: hospital admissions and stays, cholesterol exams, dental checkups, and mammograms. In the few areas where there was a statistically significant difference in health care use, it was small. The self-employed, for instance, were 6 percent less likely to visit a doctor. Even after controlling for other variables that might affect people's propensity to use health care—such as age, education, or ethnicity—similar results held.

For those concerned, as ever, about "the children," Perry and Rosen also found that "the children of the self-employed are about as likely to visit the doctor or be admitted to the hospital as the children of wage-earners." They conclude, "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."