56. Impact of Health Insurance on Healthcare and Medical Expenditures among Construction Workers
Healthcare services are necessary for managing and preventing disease, disability, and premature death.1 Unfortunately, many construction workers fail to receive the care they need because they lack health insurance coverage from any source (see page 26).
Health insurance coverage has a particularly large impact on use of healthcare.2 In 2015, about 55% of uninsured (see page 26) construction workers did not have a usual source of care when sick, compared to 12% among their counterparts with health insurance (chart 56a). About 60% of Hispanic workers that had no health insurance lacked a usual source of care when sick, while the percentage reduced to less than 15% among Hispanic workers that had insurance. A similar pattern was found among white, non-Hispanic workers.
Lack of health insurance significantly increases the likelihood of using emergency room services. On average over a three-year period, over 9% of uninsured construction workers usually visited the hospital emergency room for healthcare when sick, compared to less than 1% of their insured counterparts (chart 56b). Although ethnic disparities remain, the gap in healthcare access and utilization is narrower among insured workers. These findings are consistent with research on the impact of the Affordable Care Act.3-6
Having health insurance also affects frequency of care. Construction workers without health insurance have fewer visits to healthcare providers. In 2015, 58% of uninsured Hispanic construction workers had not seen a doctor or health professional in more than 12 months, compared to just 24% of insured Hispanics and 17% of insured white, non-Hispanics (chart 56c). As a result, close to half (45%) of uninsured Hispanic workers did not receive any preventive care, such as a regular physical exam or check-up, flu shot etc., within the past year, compared to only 13% of insured Hispanic workers (chart 56d).
Health insurance status plays an important role in the payments made to healthcare providers and institutions, also known as medical expenditures (see Glossary). Among uninsured construction workers, the average medical expenditures for both Hispanics and white, non-Hispanics were much lower than those of their insured counterparts. Insured Hispanics had more than five times, and white, non-Hispanics more than four times the medical expenditures of their uninsured counterparts (chart 56e).
In addition to ethnicity and insurance coverage, medical expenditures are also affected by age. Medical expenditures among insured workers increased steadily with age and soared after age 65 (chart 56f). Older workers are more likely to have medical conditions (see page 54), which can significantly increase overall medical costs in a worker’s later years.7 Another explanation could be that uninsured older workers may delay health services until they are eligible for Medicare.8 Given that retirement is a time when many workers experience a loss of employment-based health insurance, workers retiring or losing jobs prior to age 65 are at a higher risk for lack of healthcare access.
The data used for this page were obtained from the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS). The NHIS provides more detailed information on health behaviors, while the MEPS data cover healthcare use, expenditures, and sources of payment.
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Medical expenditures – include payments from all sources to hospitals, physicians, other medical care providers, and pharmacies for services received for medical conditions reported by respondents. Sources include direct payments from individuals, private insurance, Medicare, Medicaid, workers’ compensation, and miscellaneous other sources. Expenditures for hospital-based services include those for both facility and separately billed physicians’ services. Over-the-counter drugs, alternative care services, and telephone contacts with medical providers are not included.
1. Office of Disease Prevention and Health Promotion. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services (Accessed November 2017).
2. Agency for Healthcare Research and Quality. 2015 Medical Expenditure Panel Survey, Tables of Access to Care. Table 3a. Health insurance coverage of the civilian noninstitutionalized population: Percent by type of coverage and perceived health status, United States, 2015. https://meps.ahrq.gov/data_stats/summ_tables/hc/hlth_insr/2015/t3a_c15.htm (Accessed July 2017).
3. Wang X, Largay J. Dong XS. 2015. Impact of the Affordable Care Act on health insurance coverage and healthcare utilization among construction workers. CPWR Quarterly Data Report, https://www.cpwr.com/wp-content/uploads/publications/4th%20Quarter%20QDR.pdf (Accessed December 2017).
4. Chen J, Vargas-Bustamante A, Mortensen K, Ortega A. 2016. Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2): 140-146.
5. Buchmuller T, Levinson Z, Levy H, Wolfe B. 2016. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. American Journal of Public Health, 106(8): 1416-1421.
6. McMorrow S, Long S, Kenney G, Anderson N. 2015. Uninsurance disparities have narrowed for black and Hispanic adults under the Affordable Care Act. Health Affairs, 34(10): 1774-1778.
7. Jimenez D, Schmidt A, Kim G, Le Cook B. 2017. Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults. International Journal of Geriatric Psychiatry, 32(8): 909-921.
8. Du Y, Xu Q. 2016. Health disparities and delayed health care among older adults in California: A perspective from race, ethnicity, and immigration. Public Health Nursing, 33(5): 383-394.
All charts – Data cover all employment.
Charts 56a-56d – National Center for Health Statistics. 2015 National Health Interview Survey. Calculations by the CPWR Data Center.
Charts 56e and 56f – Agency for Healthcare Research and Quality. 2015 Medical Expenditure Panel Survey. Calculations by the CPWR Data Center.