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The effect of self-employment on health, access to care, and health behavior

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DOI: 10.4236/health.2013.512289    3,537 Downloads   4,817 Views   Citations


The focus of this paper is to investigate the role self-employment conceptualized as a lifestyle factor on health, access to health care, and health behaviors. We analyze rich data on 13,435 working adults in the US, who are either selfemployed or salaried workers. Outcomes include physical and mental health perception, validated indexes of physical and mental health, and medical conditions; access-to-care measures such as a barrier to obtaining necessary health care; and health behaviors such as smoking, physical activity and body mass index. Instrumental variables methods are used to correct for selection into self-employment. We find that self-employment is positively associated with perceived physical health, and is negatively associated with having diabetes, high blood pressure, high cholesterol and arthritis. No mental health outcome is significantly associated with self-employment. There is no significant difference between self-employed and wage-earning individuals with regard to access to care. Self-employed individuals are less likely to smoke, and are more likely to participate in physical activity and have normal-weight. We conclude that despite lack of health insurance, self-employed persons in the US are as healthy as wage-earners, do not experience a greater barrier to access to care, and are more likely to engage in healthy behavior.

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Yoon, J. and Bernell, S. (2013) The effect of self-employment on health, access to care, and health behavior. Health, 5, 2116-2127. doi: 10.4236/health.2013.512289.


[1] World Health Organization (2003) Social determinants of health: The solid facts. 2nd Edition, World Health Organization, Geneva.
[2] Benz, M. and Frey, B.S. (2004) Being independent raises happiness at work. Swedish Economic Policy Review, 12, 97-138.
[3] Blanchflower, D.G. (2000) Self-employment in OECD countries. Labour Economics, 7, 471-505.
[4] Blanchflower, D.G. and Oswald, A. (1998) What makes an entrepreneur? Journal of Labor Economics, 16, 26-60.
[5] Anderson, P. (2008) Happiness and health: Well-being among the self-employed. Journal of Socio-Economics, 37, 213-216.
[6] Taylor, M. (2004) Self-employment in Britain: When, who and why? Swedish Economic Policy Review, 12, 139-173.
[7] van der Hulst, M. (2003) Long work hours and health. Scandinavian Journal of Work, Environment, & Health, 29, 171-188.
[8] Monheit, A.C. and Vistnes, J.P. (2006) Research findings #2: Health insurance status of workers and their families, 1996. Agency for Healthcare Research and Quality, Rockville.
[9] Carper, K. and Beauregard, K. (2009) Characteristics of uninsured workers: Estimates for the US civilian noninstitutionalized population 19-64 years of age, 2006: Statistical brief No. 257. Agency for Healthcare Research and Quality, Rockville.
[10] Carroll, W. (2005) The health insurance status of US workers, 2003: Estimates for civilian non-institutionalized workers ages 16-64: Statistical brief #71. Agency for Healthcare Research and Quality, Rockville.
[11] Reinhardt, U.E. (2013) Much ado about nothing: The US Supreme Court’s rules on health reform. Health Economics, Policy and Law, 8, 125-132.
[12] Lewin-Epstein, N. and Yuchtman-Yaar, E. (1991) Health risks of self-employment. Work and Occupations, 18, 291-312.
[13] Stephan, U. and Roesler, U. (2010) Health of entrepreneurs versus employees in a national representative sample. Journal of Occupational and Organizational Psychology, 83, 717-738.
[14] Hundley, G. (2001) Why and when are the self-employed more satisfied with their work? Industrial Relations, 40, 293-316.
[15] Jamal, M. (1997) Job stress, satisfaction, and mental health: an empirical examination of self-employed and non-self-employed Canadians. Journal of Small Business Economics, 35, 48-57.
[16] Dolinsky, A.L. and Caputo, R.K. (2003) Health and female self-employment. Journal of Small Business Management, 41, 233-241.
[17] Perry, C.W. and Rosen, H.S. (2001) The self-employed are less likely to have health insurance than wage-earners. So what? NBER Working Paper, No. 8965, National Bureau of Economic Research, Washington DC.
[18] US Small Business Administration (2010) The small business economy: A report to the President.
[19] Perry, C.W. and Rosen, H.S. (2001) Insurance and the utilization of medical services among the self-employed. NBER Working Paper, No. 8490, National Bureau of Economic Research, Washington DC.
[20] Ware, J.E., Kosinski, M., Turner-Bowker, D.M. and Gandek, B. (2002) How to score version 2 of the SF-12 health survey. Quality Metrics, Lincoln.
[21] Ai, C. and Norton, E.C. (2003) Interaction terms in logit and probit models. Economic Letters, 80, 123-129.
[22] Norton, E.C., Wang, H. and Ai, C. (2004) Computing interaction effects and standard errors in logit and probit models. Stata Journal, 4, 154-167.
[23] Rivers, D. and Vuong, Q.H. (1988) Limited information estimators and exogeneity tests for simultaneous probit models. Journal of Econometrics, 39, 347-366.
[24] Blundell, R.W. and Smith, R.J. (1989) Estimation in a class of simultaneous equation limited dependent variable models. Review of Economic Studies, 56, 37-58.
[25] Terza, J.V., Basu, A. and Rathouz, P.J. (2008) Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling. Journal of Health Economics, 27, 531-543.
[26] Bruce, D. (1999) Do husbands matter? Married women entering self-employment. Small Business Economics, 13, 317-329.
[27] Lin, Z., Picot, G. and Compton, J. (2000) The entry and exit dynamics of self-employment in Canada. Small Business Economics, 15, 105-125.
[28] Borjas, G.J. (1986) The self-employment experience of immigrants. Journal of Human Resources, 21, 485-506.
[29] Yuengert, A.M. (1993) Testing hypotheses of immigrant self-employment. Journal of Human Resources, 30, 194-204.
[30] Broussard, N., Chami, R. and Hess, G.D. (2003) Why do self-employed parents have more children? CESifo Working Paper, No. 1103, Center for Economic Studies & Ifo Institute, Munich.
[31] Staiger, D. and Stock, J.H. (1997) Instrumental variables regression with weak instruments. Econometrica, 65, 557-586.
[32] Hansen, L. (1982) Large sample properties of generalized method of moments estimators. Econometrica, 50, 1029-1054.
[33] Long, J.S. and Freese, J. (2006) Regression models for categorical dependent variables using Stata. 2nd Edition, Stata Press, College Station.
[34] US Department of Health and Human Services (1999) Mental health: A report of the Surgeon General—Executive summary. US Department of Health and Human Services, Rockville.
[35] Pauly, M.V. (1968) The economics of moral hazard: Comment. American Economic Review, 58, 531-537.
[36] Cohen, S.B. (2009) Attitudes toward health insurance and their persistence over time, adults 2006-2007: Statistical brief No. 260.

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