Extensive and intensive margins of health insurance demand
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This study examined the associations between health, healthcare utilization, financial worry, and behavioral risk factors, and the extensive and the intensive margins of health insurance demand within the framework of Andersen’s behavioral model of healthcare utilization and Prospect Theory. The extensive margin refers to the decision to enroll in health insurance, the intensive margin is the perceived quality of health insurance coverage, and healthcare utilization is the number of visits to a physician annually. The study used the 2013 National Health Interview Survey data and generalized path analysis. There was no direct association between current health status and the extensive margin, and none found between health changes from the previous year and the extensive margin. Healthcare utilization, financial worry, and behavioral risk factors directly and indirectly influenced the extensive margin. Those who visited physicians more often were more likely to have health insurance, while those less worried about finances were more likely to have insurance. Those who smoked more were also less likely to have health insurance. The indirect influence of the number of physician visits, financial worry, smoking, drinking, and physical activity on health insurance was mediated through health status and health status change. There was no direct association between health status and healthcare utilization with the intensive margin. However, a direct association between the margin with health status change and with financial worry was established; those who were in better health than in the previous year had a higher probability of having better health insurance coverage compare to a year ago. Those who were more worried about their finances had a lower probability of having better health insurance coverage than in the previous year. Demographic controls included age, education, gender, race, marital status, and income, as well as functional limitations and the Biomass Index.