Disparities in employer-based health insurance coverage for working-age individuals with disabilities.

摘要

Evidence has shown that improving public health services, access to a usual source of care, health insurance coverage, and improving the quality of health services are all important strategies to overcome disparities for the larger population. However, to date, scarce research is available which examines these issues for individuals with disabilities. This study focuses on the question of employer sponsored insurance (ESI) coverage through the current main job (CMJ) for individuals with disabilities. Using the 2003--2007 Medical Expenditure Panel Survey Household Component data files, the study sample consisted of working-age adults (aged 18--64) who were employed at least part time during the year of reference (n=62,970). Two research questions were examined: (a) among people with disabilities who are employed, what is the likelihood of having ESI coverage through the CMJ, relative to people without disabilities; and (b) what are the predictors of having ESI insurance through their CMJ; specifically, to what extent does the nature of the disability, individual sociodemographic characteristics, and characteristics of the job/employer predict the likelihood that an employee will have ESI through his/her main job?;Multivariate analyses were conducted to evaluate how well each of four models (disability; disability and demographics; disability, demographics, and employment characteristics; and disability, demographics, employment characteristics, and firm characteristics) predicted the dependent variable of health insurance held through the CMJ. Study findings demonstrated that the presence of ESI through the CMJ was significantly associated with the type of disability, as individuals with certain disabilities had lower odds of holding employer-based coverage through the CMJ when unadjusted for sociodemographic and firm characteristics.;However, study findings showed that physical limitations remained the only significant disability category when all individual sociodemographic, firm, and employment characteristics were incorporated in the final model comparing individuals with and without disabilities. Among individuals with disabilities, those with functional limitations had lower odds of having ESI through their CMJ, relative to the reference group of individuals with work limitations. Research results indicate that more complete models are needed to explain disparities in ESI coverage through the CMJ and the complex relationships among disabilities, firm, employment, and demographic characteristics.