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 i ndividual purchase of insurance, with or without subsidies. OBJECTIVES. To study the associations of factors including minority-group m embership, education, income, wealth, and health status with the voluntary purchase of nongroup, private health insurance. DESIGN. Analysis of the 1987 National Medical Expenditure Survey (NMES). SUBJECTS. Adult respondents to the NMES who were younger than 65 years of a ge in 2574 health-insurance eligibility units (HIEUs) and who either were u ninsured or who purchased nongroup, private health insurance for all of 198 7. MEASURES. 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 purch ase insurance than higher-income and wealthier HIEUs, with income and wealt h measures having relatively independent effects. With simultaneous adjustm ent for income, wealth,;and other factors, members of minority groups had l ess 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 t heir own health insurance, even after adjustment for income and wealth. Pro grams encouraging the voluntary purchase of health insurance are likely to widen coverage gaps between historically disadvantaged groups and others.