The impact of insurance coverage on consumer utilization of health services

Abstract

Purpose – The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization. Design/methodology/approach – The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care. Findings – Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors. Research limitations/implications – This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access. Practical implications – The research offers a tactical framework for management to segment consumer markets more effectively. Social implications – Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome. Originality/value – The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.