The institution of employer-based health insurance, through which 65 percent of Americans receive coverage, is changing in response to federal and state insurance regulations, changes in labor market participation, and managed care growth. Employer-level decisions regarding the provision of health care coverage determine the choice set from which employed individuals and their dependents make decisions about their demand for insurance. The purpose of this project is to examine household decision- making regarding employer-sponsored health insurance. Specifically, this study will identify household-specific and health plan-specific factors that affect coverage decisions, estimate a model of demand using two nationally representative data sets, and discuss the empirical results as they relate to health plan switching, employer offerings, and antitrust enforcement. An expected utility framework will be adopted to structure the analysis and a discrete-choice modeling approach will be used for empirical estimation. The 1987 National Medical Expenditure Survey (NMES) and the newly released, 1996 Medical Expenditure Panel Survey (MEPS) are proposed for use in this study. This project will make three primary contributions. First, it will contribute to our knowledge of the demand for health care coverage by explicitly modeling the decision-making process of both single worker and two-worker households. Second, it will provide an assessment of the impacts of managed care and subsequent changes in employer-sponsored health insurance on household decision-making between 1987 and 1996. Finally, this study will provide current estimates of the demand for health care coverage that are generalizable to a national population.
