Long S H, Marquis M S
RAND, Washington, DC.
Health Aff (Millwood). 1993;12 Suppl:282-93. doi: 10.1377/hlthaff.12.suppl_1.282.
According to data from the May 1988 Current Population Survey, 18 percent of workers are in firms that do not offer health insurance. The question explored here is whether the absence of insurance in these firms is related to lack of supply (that is, a failure of the firm to offer the benefit because the price it faces is too high or the benefit too low) or lack of demand (that is, employees in these firms would not purchase the insurance even if it were offered). Characteristics hypothesized to affect the supply of insurance by firms (size, rate of turnover, and union status) are found to distinguish whether or not firms offer insurance. The data show near-universal acceptance of group insurance among employees offered the opportunity to participate. Both of these factors suggest a failure of supply. However, employees in firms that do not offer insurance are young, low-wage earners who work part time. These are also characteristics of workers who do not purchase group insurance even when it is offered, suggesting that many of the workers who are not offered group insurance would not participate in a plan even if the supply failure were corrected. These findings have implications for the effectiveness of voluntary strategies to improve access, but they also raise concern over the fairness to workers of mandates requiring that they purchase coverage.
根据1988年5月《当期人口调查》的数据，18%的工人所在公司不提供医疗保险。这里探讨的问题是，这些公司不提供保险是与供应不足（即公司因面临的价格过高或福利过低而未能提供该福利）还是需求不足（即这些公司的员工即使有保险也不会购买）有关。据发现，那些被假设会影响公司保险供应的特征（规模、周转率和工会状况）能够区分公司是否提供保险。数据显示，在有机会参与团体保险的员工中，团体保险的接受程度几乎是普遍的。这两个因素都表明存在供应不足的情况。然而，所在公司不提供保险的员工都是年轻的低薪兼职工人。即使提供团体保险，这些工人也不会购买，这表明许多没有获得团体保险的工人即使供应不足的问题得到解决，也不会参与保险计划。这些发现对旨在改善医保覆盖范围的自愿策略的有效性具有启示意义，但它们也引发了对要求工人购买保险的强制规定对工人公平性的担忧。
