Association of having multiple employer-sponsored health insurance plans and the number of physician visits: When a couple can purchase two plans from two different employers

Research Objective: I investigate whether non-elderly individuals in the United States who are covered by two employer-sponsored health insurance plans have higher levels of health service utilization than those with one employer-sponsored plan. While most Americans have only one insurance plan or none at all, an estimated 7.6 percent of the non-elderly population holds two employer-sponsored plans concurrently. An individual is eligible for two plans when a husband and wife are each eligible for separate employer or group-sponsored plans. I expect that families would hold both plans only when there is significant insurance premium subsidy for both plans and/or the additional net benefits would accrue with the dual coverage. The levels of additional service utilization among individuals with multiple coverage have not been adequately demonstrated to date. Study Design: I used the 2007 Health Tracking Household Survey, which collected nationally representative individual-level data. I restricted the sample to individuals in families in which both spouses are non-elderly workers and both are offered health insurance from their employers. In 2007, an estimated 21.7 percent of the non-elderly respondents in the study fit these criteria, leading to a final study sample of 3,141 individuals in 1,191 families. I used a negative binomial model to examine the association of having multiple employer-sponsored plans and the number of physician visits in the preceding year. We controlled for other demographic, socio-economic, and health statuses. Principal Findings: On average, individuals visited physicians 3.66 times during the preceding 12 months. Among those eligible for two employer-sponsored plans, 35.1 percent (= 1,102 out of 3,141 individuals) actually hold two employer-sponsored plans. The estimation results indicate that those with multiple employer-sponsored plans visit physicians 1.13 times (95% CI = [1.01, 1.26], p-value = 0.044) more in the preceding year than individuals with one employer-sponsored plan. Conclusions and Policy Implications: Individuals appear to use more medical care when they have multiple employer-sponsored health insurance plans. Little is known about the motivation for concurrently holding multiple employer-sponsored plans and subsequent association with service utilization. Understanding more about this may help policymakers as some of the most important issues in health policy debates include how to ensure fair access to insurance and how to determine efficient levels of medical care utilization. Furthermore, insurance provision costs should be considered across society as a whole, as families with two health insurance plans also often incur additional premium costs for the second plan's coverage.