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Social Inequalities in Health Insurance Coverage and Health: Lessening Selection Bias with Fixed Effects Regression
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Draft – Please do not cite without permission
Social Inequalities in Health Insurance Coverage and Health in the U.S.:
Addressing the Selection Bias in Health and SES with Fixed Effects Regression
Amélie Quesnel-Vallée, M.Sc. M.A.*Department of SociologyDuke University
Abstract
This paper will determine the extent to which health insurance has an impact on health, net
of that of more conventional measures of socioeconomic status (SES), namely education andincome, using data from the 1979 National Longitudinal Survey of Youth. As previous researchindicates, a satisfactory answer to this question requires estimates of the effects of healthinsurance on health that are less affected by selection biases. This will be achieved by framingthis question within the counterfactual account of causality and using fixed effects models withsibling clusters to corroborate – or refute – the results of a conventional OLS regression. Fixedeffects models postulate that, by using one sibling virtually as a “control” for another one, it ispossible to estimate the effects of current factors net of common family background and geneticpredispositions (Guo and VanWey 1999).
Results show that, despite the inclusion of control variables antedating the measure of
health insurance coverage, public insurance has in the conventional regression a strong negativeassociation with health. However, as hypothesized, this negative relationship declines inmagnitude and becomes non significant in the fixed effects regression with sibling clusters.Conversely, the effects of years uninsured, which were non significant in the OLS regression,increase in magnitude and become highly significant in the fixed effects regression. Privateinsurance had no significant effect on health beyond that of adult SES in either model.
These results suggest that being uninsured has a strong negative impact on health, while
public and private insurance may have no impact beyond that of adult SES. However, thisrelationship can only be observed with methods that specifically address the selection bias inhealth insurance allocation.
* Duke University, Box 90088, Durham, NC 27708-0088,
## email not listed ##
. I wish to thank the
Fulbright Foundation and the Social Sciences and Humanities Research Council of Canada fortheir support of my research through their doctoral fellowships.
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| | Authors: Quesnel Vallee, Amelie. |
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Draft – Please do not cite without permission
Social Inequalities in Health Insurance Coverage and Health in the U.S.:
Addressing the Selection Bias in Health and SES with Fixed Effects Regression
Amélie Quesnel-Vallée, M.Sc. M.A.*
Department of Sociology
Duke University
Abstract
This paper will determine the extent to which health insurance has an impact on health, net
of that of more conventional measures of socioeconomic status (SES), namely education and
income, using data from the 1979 National Longitudinal Survey of Youth. As previous research
indicates, a satisfactory answer to this question requires estimates of the effects of health
insurance on health that are less affected by selection biases. This will be achieved by framing
this question within the counterfactual account of causality and using fixed effects models with
sibling clusters to corroborate – or refute – the results of a conventional OLS regression. Fixed
effects models postulate that, by using one sibling virtually as a “control” for another one, it is
possible to estimate the effects of current factors net of common family background and genetic
predispositions (Guo and VanWey 1999).
Results show that, despite the inclusion of control variables antedating the measure of
health insurance coverage, public insurance has in the conventional regression a strong negative
association with health. However, as hypothesized, this negative relationship declines in
magnitude and becomes non significant in the fixed effects regression with sibling clusters.
Conversely, the effects of years uninsured, which were non significant in the OLS regression,
increase in magnitude and become highly significant in the fixed effects regression. Private
insurance had no significant effect on health beyond that of adult SES in either model.
These results suggest that being uninsured has a strong negative impact on health, while
public and private insurance may have no impact beyond that of adult SES. However, this
relationship can only be observed with methods that specifically address the selection bias in
health insurance allocation.
* Duke University, Box 90088, Durham, NC 27708-0088,
Fulbright Foundation and the Social Sciences and Humanities Research Council of Canada for
their support of my research through their doctoral fellowships.
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