Access to health care involves affordability, which is often linked to health insurance coverage, as well as the availability of health care facilities and providers. The self-employed are less likely to have access to employer-sponsored health insurance plans, and rural areas may have fewer options for local health care. From the perspective of availability and affordability, this report studies access to health care for the self-employed, their families and households in non-metro counties, using data collected between 2014 and 2020 The results indicate that rates and sources of health insurance coverage differ more by age and whether workers are self-employed than by whether they live in a metropolitan or non-metropolitan area.
Keywords: Access to care, health insurance, health care costs, self-employed, non-metro,
What is the solution?
Access to health care involves affordability, which is often linked to health insurance coverage, as well as the availability of health care facilities and providers. The self-employed are less likely to have access to health insurance schemes than workers employed by government or private companies, and rural areas may have fewer health care facilities or face other barriers to accessing care. We compared health insurance coverage and medical expenditures between the self-employed and workers employed by private industry and governments, and their households and families, in metropolitan (metro) and non-metropolitan (non-metro) counties. metropolitan areas) between 2018 and 2020. We also compared and provider availability by the share of self-employed in a county among different localities for the period 2014 to 2019.
What did the study find?
Rates and sources of health insurance coverage differed more by age and by whether workers were self-employed than by whether workers lived in a metropolitan or non-metropolitan area. In 2018, self-employed adults of working age were more likely to be uninsured than those employed by the government or other employers. However, a household made up of both self-employed and private or public workers was almost three times less likely to be completely uninsured than a single self-employed person.
More non-metropolitan independent working-age adults were insured through employer (group) plans than any other source of insurance, likely because they were covered by another employer’s plan household member. However, direct purchase schemes covered more self-employed adults of working age than those employed in the public or private sector. In addition, the share of non-metropolitan self-employed working-age adults with public insurance (eg, Medicaid, Medicare) was twice that of those employed by government or the private sector.
Adults of retirement age, including the self-employed, and their households were less likely to be uninsured than adults of working age. These adults and households were also more likely to be covered by public insurance and to have multiple sources of health insurance coverage.
In 2018, family medical expenses differed more by age and source of health insurance coverage than by metro status or whether family members were self-employed. About half of medical expenses went to insurance premiums, while the other half went to personal expenses on deductibles, copays and over-the-counter products. Families with direct purchase plans paid the most in premiums per person, on average, while families with public plans paid the least. These spending patterns were consistent across age, whether family members were self-employed, and whether the family lived in a metropolitan area. Families with retirement-age adults had higher medical expenditures per person, on average, than those without retirement-age adults.
The availability of health care facilities and providers varied widely across census regions and metropolitan and non-metropolitan locations in
Regional and metropolitan trends in the availability of hospital beds, doctors and dentists per 10,000 population varied more than the number of medical facilities in 2017. The lowest rates of primary care doctors and dentists were found in counties where the proportion of self-employed was high. the South and the Midwest, while the Northeast generally had the highest rates, regardless of the composition of the county’s workers. For institutional beds, availability rates were generally higher in non-metro counties than in metropolitan counties, but no major patterns existed between counties with different worker compositions.
Differences in uninsured rates between independent working-age adults and those employed by government or private industry persisted throughout the COVID-19 pandemic in 2020, but rates of uninsured were higher at the start of the pandemic in April and May 2020 than in 2018 .
How was the study conducted?
We defined rural communities as non-metro counties, where the urban core has a population of less than 50,000 and where there are no strong commuting links with an urban core of at least 50,000, and all other areas like metro. Estimates of the self-employed population, their health insurance coverage (and that of their households) and their family medical expenses in 2018 were obtained from the annual social and economic supplement to the population survey 2019 data. Data on health care facilities and health care providers in the county was obtained from the 2018-19 region health resource file and was supplemented using data on the county. share of self-employed from 2014-18.
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