Original Article Investigating the significance of insurance and income on health service utilization across generational cohorts Received (in revised form): 04th October 2015 Genevieve E. O’Connor (PhD) is an assistant professor of marketing at the Fordham University Schools of Business. Professor O’Connor is a services marketing strategist who specializes in health care, product and brand management as well as relationship management. She has presented her research to organizations such as the American Marketing Association and INFORMS Marketing Science. Professor O'Connor has conducted research and provided expert consultation for health-care projects and has more than 10 years of industry experience with Fortune 500 companies, including 3M, US Surgical and Boston Scientific. ABSTRACT Ensuring access to health services is critical to consumers’ well-being across generational cohorts. Based on pre-disposing characteristics (that is, gender, ethnicity) and financial resources (that is, insurance and income) certain consumers may face barriers to access. In attempt to improve access to health care, this article presents an empirical investigation into how health service utilization can be affected by enabling variables, namely insurance and income. Utilizing proprietary secondary data from a major metropo- litan hospital in the United States, the article investigates the following questions: How does insurance and income enable service utilization? How do pre-disposing characteristics of a consumer hinder service access? How does the effect of income and insurance moderate the effect of pre-disposing factors on service utilization? Finally, how do these effects on service utilization vary across generational cohorts? Results indicate that insurance and income may enable access to service, yet this effect is varied among different demographic cohorts and generational groups. The article concludes by offering implications for mar- keters and policymakers. Journal of Financial Services Marketing (2016) 21, 19–33. doi:10.1057/fsm.2015.23 Keywords: insurance; income; financial exclusion; generational cohorts; service utilization; health care INTRODUCTION Disparities in health-care access and the ensuing adverse health-care outcomes represent a significant problem that affects low-income and affluent countries alike. In affluent countries, comprehensiveness of care, equitable care, timeliness and outcomes of care are still under great scrutiny; whereas in low-income countries, consumers struggle to attain basic health services (Gulliford et al, 2013). The concept of service access is multidimensional; it Correspondence: Genevieve E. O’Connor, Gabelli School of Business, Fordham University, 113 West 60th Street, 6th Floor, New York, 10023, USA. E-mail: geoconnor@fordham.edu © 2016 Macmillan Publishers Ltd. 1363-0539 Journal of Financial Services Marketing Vol. 21, 1, 19–33 www.palgrave-journals.com/fsm/