Reducing disparities in access to health care is a long-standing objective of the federal government. Building on research showing that marriage can provide important resources for obtaining needed health care, we suggest that racial and ethnic differences in marriage could explain persistent disparities in access. Using data from MEPS and NLSY we investigate the association between marriage and access to health care among men, and estimate the extent to which racial and ethnic differences in both the returns to marriage and marital rates explain differences in access and preventive service use. We find that marriage accounts for up to 24 % of racial and ethnic differences in access and preventive use. The returns to marriage for whites and blacks, however, are greater than that for Hispanics. We suggest that differences in spousal characteristics such as education and income could explain why whites and blacks benefit from marriage more than Hispanics. We find support for this hypothesis: differences in spousal characteristics account for up to 37 % of the gap in access and preventive use among married adults.
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The extent to which couples pool and share their income is an empirical question. Literature generally finds presence of income sharing and pooling among couples but bargaining power also plays an important role within a household (Benke 2015).
Limiting the sample to individuals in scope and with responses to preferences to care reduced the sample size by 3 and 14 %, respectively.
These percentages are unweighted.
In defining this indicator we have not differentiated whether an individual is a policy holder of coverage, a dependent of spousal coverage, or both (double coverage). Abraham and Royalty (2005) find that having a second earner in a household improves quality of health insurance and, subsequently, improve individual’s access to care. We expect that sources of coverage would differ across racial/ethnic groups and examination of this issue certainly deserves attention in the future analyses.
The direction of bias will depend on types of variables omitted in the model. This issue is discussed in the next section but, overall, it is difficult to conclusively determine the direction of bias in this application.
Although there is no clear theoretical guidance on the choice of estimates (Neumark 1988), for practical purposes, we are interested in identifying contribution of differences in marital rates holding other factors constant as opposed to assuming that minorities would take whites’ returns to marriage.
In paper we present the findings in absolute terms; however, in conjunction with results from Table 1, these effects could be converted to percent. In this case, the relative effects of marriage on cholesterol check for whites and physician visits for Hispanic are 35.7 and 9.3 %, respectively.
For instance, in labor economic applications that examine differences in wages between males and females, significant difference in estimates is usually interpreted as presence of discrimination in labor markets (Neumark 1988).
The analysis uses linear probability models to identify the estimates of interest and then decomposes the difference in access to care using spousal characteristics. See Sect. 5 for more details.
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Pylypchuk, Y., Kirby, J.B. The role of marriage in explaining racial and ethnic disparities in access to health care for men in the US. Rev Econ Household 15, 807–832 (2017). https://doi.org/10.1007/s11150-015-9300-2