The effect of self-employment on health, access to care, and health behavior

Abstract

The focus of this paper is to investigate the role self-employment conceptualized as a lifestyle factor on health, access to health care, and health behaviors. We analyze rich data on 13,435 working adults in the US, who are either selfemployed or salaried workers. Outcomes include physical and mental health perception, validated indexes of physical and mental health, and medical conditions; access-to-care measures such as a barrier to obtaining necessary health care; and health behaviors such as smoking, physical activity and body mass index. Instrumental variables methods are used to correct for selection into self-employment. We find that self-employment is positively associated with perceived physical health, and is negatively associated with having diabetes, high blood pressure, high cholesterol and arthritis. No mental health outcome is significantly associated with self-employment. There is no significant difference between self-employed and wage-earning individuals with regard to access to care. Selfemployed individuals are less likely to smoke, and are more likely to participate in physical activity and have normal-weight. We conclude that despite lack of health insurance, self-employed persons in the US are as healthy as wage-earners, do not experience a greater barrier to access to care, and are more likely to engage in healthy behavior.

Prevalence and factors associated with tobacco use among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality, South Africa

“…Participants with no formal education as well as those who were self-employed had a higher prevalence of cigarette smoking. This was contrary to the report of Yoon and Bernell, 52 who contend that self-employed individuals were less likely to smoke compared with those who were employed. Du and Leigh 53 stated that the higher the income, the less likely the risk of smoking.…”

Physical and mental health problems of self‐employed small business owners in South Korea

“…Based on the Job‐Demand Control Model, a traditional framework on occupational stress produced by workplace stressor and job control, one perspective suggests that entrepreneurs experience better health than those in other types of employment . Self‐employed persons may be in an active job situation due to the high workload but high decision authority for their work, thus having higher levels of life satisfaction, and well‐being, better health behaviors (eg, physical activity, and smoking), and healthier bodies (eg, less hypertension, and low blood pressure) . The other perspective, however, presents self‐employed individuals as those who will struggle with ill health due to high levels of job demand and work intensity leading to self‐exploitation .…”

Self-Employment and Health: Barriers or Benefits?

“…While some of the earlier‐mentioned papers show that self‐employment has health benefits, others show that the self‐employed are at higher risk for certain diseases than wageworkers (Lewin‐Epstein and Yuchtman‐Yaar, ; Buttner, ; Jamal, ; Parslow et al , ; Dahl et al , , Yoon and Bernell, ). The cited studies emphasize structural differences between self‐employment and wage work to explain the difference in health between the self‐employed and wageworkers.…”

“… Yoon and Bernell () use an instrumental variable approach to overcome the selection problem, yet their instruments include the number of self‐employed family members, immigrant status, years of labor market experience, the number of children, and having uninsured children, all of which are likely to have a direct relation with health, and thus violate the exclusion restriction.…”