The phenomenon of job-lock in the United States may be caused by a major non-portable fringe benefit provided by employers: health insurance. Would-be entrepreneurs and other self-employed individuals may not be achieving their full potential due to being “locked” in their wage-employment. With data from the Survey of Consumer Finances in years 2004, 2007, and 2009, this study explores this effect, whether it exists, and whether it is lessened by worse health status. Amongst married households, there is evidence that husbands are 9.2% more likely to be entrepreneurs if their spouses have employer coverage, whereas wives are not. Somewhat surprisingly, this effect is not associated with health care demand. Amongst non-married individuals, employer coverage restricts transitions into self-employment by 3.6%. Both of these results provide evidence for job lock, and have loose implications on how universal healthcare may free individuals to pursue entrepreneurship.

Cette thèse s’intéresse, en France, à la place de l’assurance maladie privée (ou complémentaire) dans l’organisation globale du système d’assurance, sous l’angle des inégalités sociales et de la solidarité entre les individus bien-portants et les malades. Elle étudie en particulier le rôle joué par l’assurance complémentaire sur l’accès aux soins, la mutualisation des dépenses de santé et le bien-être de la population. Les travaux menés dans cette thèse révèlent l’importance de l’assurance complémentaire pour accéder à des soins reportés dans le temps pour raisons financières. Ils montrent en revanche que, généraliser l’assurance complémentaire, dans le modèle actuel de co-financement des soins, ne permet ni de répondre à des objectifs d’équité ni-même d’améliorer le bien-être de la population. Ils révèlent en sus que l’assurance complémentaire induit une moindre mutualisation des dépenses de santé pour les plus malades et invitent à repenser son rôle dans le financement des soins. / This thesis deals with the place of private health insurance in the overall health insurance scheme in France, focusing on social inequalities and on solidarity between healthy individuals and sick patients. It particular, it addresses the role of private health insurance on access to health care, mutualization of health expenditure, and welfare. The results of this thesis reveal the key role of private health insurance to access to care postponed over time for financial reasons. However, our results also show that generalizing complementary health insurance in the current health insurance scheme does not allow pursuing equity goals nor increasing welfare. They finally reveal that the mutualization induced by private health insurance appears relatively weak, compared to the one induced by public health insurance. They therefore encourage a change in the role of private health insurance in funding medical care.