Healthcare Access and Health Status by Primary Source of Health Insurance and Occupation

In the United States, health insurance is strongly associated with healthcare access and health status. How health insurance source, healthcare access, and health status differ by occupation has received less attention.

We used responses to the 2022 and 2023 Behavioral Risk Factor Surveillance System to estimate the prevalence of primary health insurance source, healthcare access/unmet healthcare needs, and health status by demographic characteristics and major occupation among respondents employed for wages or self-employed. We generated prevalences and adjusted prevalence ratios (PRs) to examine healthcare access and self-reported health status for workers in each occupation and to understand the impacts of adjustment for demographic characteristics (age, sex, race/Hispanic ethnicity), health insurance source, and household income.

Overall, being insured was associated with better healthcare access and self-reported health status. Workers with employer-sponsored insurance or non-group private insurance were least likely to report unmet healthcare needs or to rate their health status as fair or poor. The uninsured were most likely to report unmet healthcare needs. The four occupations with at least 25% of workers uninsured (Farming, Fishing and Forestry; Building and Grounds Cleaning and Maintenance; Food Preparation and Serving; and Construction and Extraction) had statistically significant unadjusted PR elevations for all unmet healthcare need measures and for fair or poor general health. After sequential adjustment for demographic covariates and then primary insurance source, statistically significant elevations remained for being unable to afford needed care and for reporting fair or poor general health in most low-wage occupations. Final adjustment, adding household income, eliminated these remaining elevations for most occupations.

Both healthcare access and health status vary by health insurance status and source, which are differentially distributed by occupation. Workers in lower-wage occupations may have trouble affording medical care, even if insured. Affordable, comprehensive health insurance coverage, along with wages adequate to cover needed care, could help ensure the health and continued employability of all workers.