To buy, or not to buy: factors associated with the purchase of nongroup, private health insurance.
BACKGROUND
Employment-based health insurance coverage is declining in the United States. Many recent efforts to increase coverage have promoted the individual purchase of insurance, with or without subsidies.


OBJECTIVE
To study the associations of factors including minority group membership, education, income, wealth, and health status with the voluntary purchase of nongroup, private health insurance.


METHODS
Analysis of the 1987 National Medical Expenditure Survey (NMES).


METHODS
Adult respondents to the NMES who were younger than 65 years of age in 2,574 health-insurance eligibility units (HIEUs) and who either were uninsured or who purchased nongroup, private health insurance for all of 1987.


METHODS
Adjusted odds ratios and marginal effects for the associations of minority group membership, educational attainment, income, and wealth with the purchase of nongroup insurance.


RESULTS
Lower-income and less-wealthy HIEUs were much less likely to purchase insurance than higher-income and wealthier HIEUs, with income and wealth measures having relatively independent effects. With simultaneous adjustment for income, wealth, and other factors, members of minority groups had less than half the odds of non-Hispanic whites and persons with less than a high school education had less than half the odds of college graduates of purchasing nongroup insurance.


CONCLUSIONS
Minorities and the less educated are much less likely to buy their own health insurance, even after adjustment for income and wealth. Programs encouraging the voluntary purchase of health insurance are likely to widen coverage gaps between historically disadvantaged groups and others.
Saver
B G
BG
Department of Family Medicine, University of Washington, Seattle 98195-4696, USA. saver@u.washington.edu
Doescher
M P
MP
D000328:Adult; D004522:Educational Status; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006304:Health Status; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D016017:Odds Ratio; D012959:Socioeconomic Factors; D014481:United States