Healthy, wealthy or busy? Self-employment and healthcare services utilization in Europe

In this paper we investigate the relationship between different types of self-employment and healthcare utilization across Europe. The empirical analysis is based on 2004 and 2014 individual data for 21 European countries from the European Social Survey (ESS), which, in these two waves, contains detailed information on individual employment status and use of healthcare services. After controlling for selection into employment status, our estimates point out that, compared to the employees, the self-employed without employees are significantly less likely to use healthcare services, while no statistically significant differences emerge for the other type of self-employed (i.e., those with employees). Further exploratory analyses seem to indicate that these differences are driven by a number of factors, such as differences in perceived health, wealth and opportunity costs. An important role is played by cross-country differences in healthcare systems: in particular, we find that self-employed without employees are much less likely to use healthcare services where the latter are provided by private actors.