Three Essays on Insurance Coverage in the U.S. Healthcare System

Authors

rochelle parrino, Florida International UniversityFollow

Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Timothy Page, PhD

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Alejandro Arrieta, PhD

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Jean Hannan, PhD, ARNP, FAAN

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Jessica Adler, PhD

Fourth Advisor's Committee Title

Committee Member

Keywords

insurance, uninsurance

Date of Defense

11-4-2021

Abstract

The purpose of these three studies is to advance our understanding of the impact of the uninsured on the U.S. healthcare system and specifically the professional components, accounting for 20% of healthcare expenditures in the U.S., roughly $772 billion in 2019. Two of the three studies use linear mixed effects models investigating the consequences of uninsurance on physician providers at the county level. The first study examines the impact of community uninsurance rate on primary care and specialist providers to explain the effect that uninsurance has on the healthcare system and stress on available resources for both insured and uninsured. The second study investigates the impact of Medicaid eligibility expansion on supply of physician providers, and the impact is more serious among specialty providers than to the primary care providers. The third study using a linear regression model and the ordinary least square method to evaluate the strength of the public health infrastructure following the passage of the Affordable Care Act and the effect on insurance enrollment to identify factors for future system-wide improvements. Public health department accreditation was used as a proxy for the strength of public health infrastructure. In these studies, our results showed a statistically significant association between PCP supply and uninsurance rate. This study suggested that the availability of providers increases as uninsurance decreases. My findings also implied that the insured population suffers from a high uninsurance rate since the number of professional providers would decrease with the increase of uninsurance rate in the area. My results showed a statistically significant association between the Medicaid eligibility expansion and physician supply. The results suggested that professional providers would be influenced by the improvement of insurance rate due to Medicaid eligibility expansion since this would extend the payment methodologies of their patients thus improving their compensation. My findings also suggested that increases in insurance enrollment are greater in counties with stronger public health infrastructures. In addition, counties in stronger county public health infrastructures located in non-expansion states have a greater improvement than in the county level medical insurance enrollment with stronger county public health infrastructures and located within expansion states.

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Identifier

FIDC010429

Recommended Citation

parrino, rochelle, "Three Essays on Insurance Coverage in the U.S. Healthcare System" (2021). FIU Electronic Theses and Dissertations. 4866.
https://digitalcommons.fiu.edu/etd/4866