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03-11-2023

An examination of the impact of health insurance enrollment in reducing racial health disparities

Authors: In Jung Song, Inhyuck “Steve” Ha, Won Fy Lee, Minjung Choi

Published in: Journal of Economics and Finance

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Abstract

This paper investigates the effects of health insurance enrollment on health disparities among different racial groups in the United States. Two models were constructed and estimated empirically where a health insurance disparity model was nested in the health disparity model. The Blinder-Oaxaca decomposition method was used to measure potential racial discrimination in health status. The racial gap in health disparities was broken down by endowment and treatment effects. The results show that the health status gap can be explained by potential discrimination in health insurance enrollment between Blacks and Whites. Overall, health insurance enrollment plays a critical role in explaining racial disparities and a racial disparity in the healthcare industry explains a nontrivial portion of the differences in health status.

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Footnotes
1
Major chronic diseases are categorized as heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes (Williams et al. 2003, Williams and Mohammed 2008).
 
2
Disparities in Health and Health Care: Five Key Questions and Answers, Issue Brief (Artiga et al. 2016).
 
3
The National Cancer Institute (NCI) explains that “disparities occur when members of certain population groups do not enjoy the same health status as other groups” while the National Institutes of Health (NIH) defines a disparity as “a difference in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States”.
 
4
Economic disadvantage refers to low income or the inability to purchase goods and services, while social disadvantage indicates someone’s relative position determined by economic resources, race, ethnicity, or gender. Environmental disadvantage refers to a region where the concentration of poverty is high (Braveman 2014).
 
5
There exists a huge disparity in chronic diseases, not in acute diseases, among different races (Williams et al. 2003, Williams and Mohammed 2008).
 
6
The Centers for Disease Control and Prevention releases this survey annually.
 
7
Respondent-rated health has been shown to be a predictor of mortality, net of adjustments for clinical measures of health status (Benyamini and Idler 1999; Idler and Benyamini 1997).
 
8
Alternatively, we could use the scale variable as is, instead of dichotomizing it, using the ordered logit models. We tested the models and compared the results with those ones the binary logit models. We obtained consistent results.
 
9
Private care insurance (PCI) is further categorized into predicted PCI using logit-estimated White coefficient (WPCI), predicted PCI using logit-estimated Black coefficient (BPCI), and Original predicted PCI (WBPCI).
 
10
There are various measures of effect size, such as Cohen’s d, Hedges’s g, and Glass’s Δ, Point-biserial r and more. We include only Cohen’s d estimates due to the similarity of the measures.
 
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Metadata
Title
An examination of the impact of health insurance enrollment in reducing racial health disparities
Authors
In Jung Song
Inhyuck “Steve” Ha
Won Fy Lee
Minjung Choi
Publication date
03-11-2023
Publisher
Springer US
Published in
Journal of Economics and Finance
Print ISSN: 1055-0925
Electronic ISSN: 1938-9744
DOI
https://doi.org/10.1007/s12197-023-09650-x