Differentiating beliefs of insured and uninsured, insurance-eligible state employees: a new application of the Health Belief Model

The increasing number of uninsured Americans is a crucial policy issue for the United States; however, there is a paucity of empirical social science research on the uninsured with which to guide the development of policy. Previous research indicates that when insurance is voluntary, whether offered through a state-initiated reform to reduce uninsurance or offered through an employer as a benefit, some people choose to remain uninsured. The literature calls for research to increase understanding of the factors that affect whether people offered insurance accept or decline that insurance. Research on the uninsured is lacking a theoretical framework to help researchers and policymakers understand, predict, and explain why some people decline insurance and remain uninsured. Previous research suggests that while cost is a primary factor, there are other, unknown factors that contribute to uninsurance. The current research seeks to fill the gaps in the literature by using the Health Belief Model as a framework to explore relationships between insurance status and beliefs about insurance. Five constructs are of focus in the Health Belief Model: susceptibility, severity, benefits, barriers, and cues to action. This study, employing cross-sectional survey methods, is an observational, descriptive, and exploratory study seeking to establish relationships between demographic characteristics, health beliefs, and insurance status. The population under study is insurance-eligible, insured and uninsured employees of a large, state university, where 24% of insurance-eligible employees decline to participate in employer-offered voluntary health insurance benefits. Data were collected through a telephone survey of employees (n=140) selected through a stratified random sample. A Pearson’s correlation coefficient was calculated to examine the relationship between insurance status and various dimensions of beliefs as framed by the health belief model. Findings show a significant positive correlation between insurance status and cues to action and significant negative relationships between insurance status and barriers and insurance status and benefits. This study provides insights into the social barriers to health insurance participation. The results of this study suggest that the Health Belief Model is a useful framework with which to study the uninsured