title: Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs.
abstract: BACKGROUND
  Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals.
  
  
  METHODS
  In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component.
  
  
  RESULTS
  We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero.
  
  
  CONCLUSIONS
  Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll.
authors.affiliation: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA. pcooper@ahrq.gov
authors.forename: Philip F
authors.initials: PF
authors.lastname: Cooper
authors.forename: Jessica
authors.initials: J
authors.lastname: Vistnes
mesh_terms: D003198:Computer Simulation; D003258:Consumer Behavior / Q000191:economics / Q000706:statistics & numerical data*; D003657:Decision Making; D003669:Deductibles and Coinsurance; D004651:Employment / Q000191:economics* / Q000706:statistics & numerical data; D005249:Fees and Charges; D005382:Financing, Personal; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D017059:Models, Econometric; D015999:Multivariate Analysis; D012456:Salaries and Fringe Benefits; D014481:United States