Abstract
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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Notes
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.
References
Abraham, J. M., & Royalty, A. B. (2005). Does having two earners in the household matter for understanding how well employer-based health insurance works? Medical Care Research and Review, 62, 167–186.
Ahituv, A., & Lerman, R. (2011). Job turnover, wage rates, and marital stability: How are they related? Review of Economics of the Household, 9, 221–249.
Ali, M. M., & Ajilore, O. (2011). Can marriage reduce risky health behavior for African-Americans? Journal of Family and Economic Issues, 32, 191–203.
Andersen, R. M. (1968). Behavioral model of families’ use of health services. No. 25. Chicago, Center for Health Administration Studies, University of Chicago.
Andersen, R. M. (1995). Revisiting the behaviroal model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10.
Anglewicz, P., & Clark, S. (2013). The effect of marriage and HIV risks on condom use acceptability in rural Malawi. Social Science and Medicine, 97, 29–40.
Basu, J. (2005). Severity of illness, race, and choice of local versus distant hospitals among the elderly. Journal of Health Care Poor Underserved, 16, 391–405.
Basu, J., & Friedman, B. (2007). A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity. Health Economics, 16, 687–701.
Benke, J. (2015). Pooling of income and sharing of consumption within households. Review of Economics of the Household, 13, 73–93.
Blinder, A. (1973). Wage discrimination: Reduced form and structural variables. Journal of Human Resources, 8, 436–455.
Bordone, V., & Ludwig, V. (2009). Is marriage a protective state? A longitudinal study of families’ demand for health care. Working Paper, University of Mannheim, Graduate School of Economic and Social Sciences.
Branscome, J. (2012). Trends in premiums and employee contributions for employer-sponsored health insurance: Private sector, 1996–2011. AHRQ Statistical Brief #388.
Broman, C. (1993). Race differences in marital well-being: The significance of parental cohabitation. Journal of Marriage and the Family, 55, 724–732.
Brown, D. C., Hummer, R. A., & Hayward, M. D. (2014). The importance of spousal education for the self-rated health of married adults in the United States. Population Research and Policy Review, 33, 127–151.
Buckles, K. S., & Price, J. (2013). Selection and the marriage premium for infant health. Demography, 50, 1315–1339.
Bulanda, J. R., & Brown, S. L. (2007). Race-ethnic differences in marital quality and divorce. Social Science Research, 36, 945–967.
Chan, K. S., Gaskin, D. J., Dinwiddie, G. Y., & McCleary, R. (2012). Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care? Medical Care, 50, 692–699.
DiNardo, J., Fortin, N., & Lemieux, T. (1996). Labor market institutions and the distribution of wages. Econometrica, 64, 1001–1044.
Duncan, G., Wilkerson, B., & England, P. (2006). Cleaning up their act: the effects of marriage and cohabitation on licit and illicit drug use. Demography, 43, 691–710.
Fairlie, R. (2005). An extension of the Blinder–Oaxaca decomposition technique to logit and probit models. Journal of Economic and Social Measurement, 30, 305–316.
Fortin, N., Thomas, L., & Firpo, S. (2011). Decomposition methods in economics. In D. Card & O. Ashenfelter (Eds.), Handbook of labor economics (pp. 1–102). Amsterdam: Elsevier B.V.
Gardeazabal, J., & Ugidos, A. (2004). More on identification in detailed wage decompositions. The Review of Economics and Statistics, 86, 1034–1036.
Geruso, M. (2012). Black–white disparities in life expectancy: How much can the standard SES variables explain? Demography, 49, 553–574.
Grossbard-Shechtman, S., & Neuman, S. (2003). Marriage and work for pay. In S. Grossbard-Shechtman (Ed.), Marriage and the economy: Theory and evidence from advanced industrial societies (pp. 222–247). New York, NY: Cambridge University Press.
Grossman, M. (1972). On the concept of health capital and the demand for health. The Journal of Political Economy, 80, 223–255.
Hargraves, J. L., Cunningham, P. J., & Hughes, R. G. (2001). Racial and ethnic differences in access to medical care in managed care plans. Health Services Research, 36, 853–868.
Hemstrom, O. (1996). Is marriage dissolution linked to differences in mortality risks for men and women? Journal of Marriage and the Family, 58, 366–378.
Jacobson, L. (2000). The family as producer of health: An extended Grossman model. Journal of Health Economics, 19, 611–637.
Jovanovic, Z., Lin, C. J., & Chang, Chung-Chou H. (2003). Uninsured vs. insured population: variations among nonelderly Americans. Journal of Health and Social Policy, 17, 71–85.
Kirby, J. B., Taliaferro, G., & Zuvekas, S. (2006). Explaining racial and ethnic disparities in health care. Medical Care, 44, I64–I72.
Lavelle, B., & Smock, P. (2012). Divorce and women’s risk of health insurance loss. Journal of Health and Social Behavior, 53, 413–431.
Lillard, A., & Panis, C. (1996). Marital status and mortality: The role of health. Demography, 33, 313–328.
Miller, G. E., & Pylypchuk, Y. (2013). Marital status, spousal characteristics, and the use of preventive care. Journal of Family and Economic Issues,. doi:10.1007/s10834-013-9375-y.
Montez, J., Angel, J. L., & Angel, R. J. (2009). Employment, marriage, and inequality in health insurance for Mexican-Origin women. Journal of Health and Social Behavior, 50, 132–148.
Morenoff, J. D., House, J. S., Hansen, B. B., Williams, D. R., Kaplan, G. A., & Hunte, H. E. (2007). Understanding social disparities in hypertension prevalence, awareness, treatment, and control: The role of neighborhood context. Social Science and Medicine, 65, 1853–1866.
Nardin, R., Zallman, L., McCormick, D., Woolhandler, S., & Himmelstein, D. (2013). The uninsured after implementation of the Affordable Care Act: A demographic and geographic analysis. Health Affairs Blog. http://healthaffairs.org/blog/2013/06/06/the-uninsured-after-implementation-of-theaffordable-care-act-a-demographic-and-geographic-analysis
Neumark, D. (1988). Employers’ discriminatory behavior and the estimation of wage discrimination. Journal of Human Resources, 23, 279–295.
Oaxaca, R. (1973). Male–female wage differentials in urban labor markets. International Economic Review, 14, 693–709.
Oaxaca, R. L., & Ransom, M. R. (1994). On discrimination and the decomposition of wage differentials. Journal of Econometrics, 61, 5–21.
Patient Protection and Affordable Health Care Act (PPACA). (2010). 782 Public Law 111–148. http://www.gpo.gov/fdsys/pkg/PLAW-78311publ148/pdf/PLAW-111publ148.pdf
Pylypchuk, Y., & Hudson, J. (2009). Immigrants and the use of preventive care in the United States. Health Economics, 18, 783–806.
Pylypchuk, Y., & Selden, T. (2008). A discrete choice decomposition analysis of racial and ethnic differences in children’s health insurance coverage. Journal of Health Economics, 27, 1109–1128.
Rapp, I., & Schneider, B. (2013). The impacts of marriage, cohabitation and dating relationships on weekly self-reported physical activity in Germany: A 19-year longitudinal study. Social Science and Medicine, 98, 197–203.
Sarrazin, M., Campbell, M. E., Richardson, K. K., & Rosenthal, G. E. (2009). Racial segregation and disparities in health care delivery: Conceptual model and empirical assessment. Health Services Research, 44, 1424–1444.
Takeuchi, D. T., Walton, E., & Leung, M. (2010). Race, social contexts, and health: Examining geographic spaces and places. In C. Bird, A. Fremont, S. Timmermans, & P. Conrad (Eds.), Handbook of medical sociology (pp. 92–105). Nashville, TN: Vanderbilt University Press.
Thompson, O. (2011). Racial disparities in the cognition–health relationship. Journal of Health Economics, 30, 328–339.
Trent, K., & South, S. J. (2003). Spousal alternatives and marital relations. Journal of Family Issues, 24, 787–810.
U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services. (2010). Healthy people 2020. Washington, D.C.: US Government Printing Office. http://www.healthypeople.gov/2020/default.aspx
Viswanath, K., Breen, N., Meissner, H., Moser, R. P., Hesse, B., Steele, W. R., et al. (2006). Cancer knowledge and disparities in the information age. Journal of Health Communication, 11, 1–17.
Williams, K., & Umberson, D. (2004). Marital status, marital transitions, and health: A gendered life course perspective. Journal of Health and Social Behavior, 45, 81–98.
Wood R, Goesling B, & Avellar S. (2007). The effects of marriage on health: A synthesis of recent research evidence. Mathematica. MPR Reference No.: 6306-033.
Yun, M.-S. (2005). A simple solution to the identification problem in detailed wage decompositions. Economic Inquiry, 43, 766–772.
Zheng, X., & Zimmer, David M. (2009). Racial differences in health-care utilization: Analysis by intensity of demand. Contemporary Economic Policy, 27, 475–490.
Zimmer, D. M. (2007). Asymmetric effects of marital separation on health insurance among men and women. Contemporary Economic Policy, 25, 92–106.
Zuvekas, S. H., & Taliaferro, G. S. (2003). Pathways to access: health insurance, the health care delivery system, and racial/ethnic disparities, 1996–1999. Health Affairs, 22, 139–153.
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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
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DOI: https://doi.org/10.1007/s11150-015-9300-2