Date of Degree
Doctor of Business Administration (DBA)
Kruti R. Lehenbauer
Bob R. Kiser
Alan P. Xenakis
It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between the pre- and post-ACA era, with emphasis on the comparisons between the insured and uninsured groups in both eras. Following the health care consumption determining Andersen behavioral model (1995), this study focuses on predisposing factors, enabling factors, and need factors to determine whether preventive care for cardiovascular services is utilized at higher rates among insured individuals for each year and whether the usage of preventive care increased in the post-ACA era due to increase in the access to preventive services via the mandates regarding health insurance. For this comparative quantitative study, data were obtained for the years 2009 and 2015 from the annual Medical Expenditure Panel Surveys, which include sociodemographic, economic, and medical information for over 30,000 observations per year. The dependent variable for the analysis is the usage of cardiovascular care services including cholesterol testing and blood pressure screenings every year among adults and the key independent variable is the medical insurance status of individuals. Other sociodemographic variables include race/ethnicity variables, marital status, household income, language spoken at home, educational attainment of individual, gender, age, usual source of medical care, and self-perceived health status. The methodology involves conducting descriptive statistical analysis, inferential statistical analysis, and logistical regression analysis to compare the insured and the uninsured groups for both years of interest, as well as comparing the uninsured groups for each year with each other. While the ACA appears to have definitely resulted in a reduction in the proportion of uninsured people, the proportion of the Hispanic-minority group among the uninsured has increased, indicating a worrisome trend in the population. Neither have the general socioeconomic characteristics between the insured and the uninsured changed between the 2 years, nor have there been any changes in the characteristics of the uninsured groups except for a higher Hispanic-minority representation in 2015. The odds of getting preventive care went down for the uninsured group from 54% to 64% from 2009 to 2015 indicating that the uninsured in the post-ACA era were worse off than their pre-ACA era counterparts. Our results indicate that while having insurance might be a necessary condition for increasing the use of preventive care services as an enabling factor, it is certainly not a sufficient condition because the need and predisposing factors of an individual play a crucial role in determining their utilization of preventive care.
Peek, Brit, "Affordable Care Act and Preventive Care Usage: A Mixed Method Analysis of Cardiovascular Care" (2019). Theses & Dissertations. 364.