Electronic Theses and Dissertations

Date

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Systems & Policy

Committee Chair

Aram Dobalian

Committee Member

Kenneth Ward

Committee Member

Paige Powell,

Committee Member

Meredith Ray

Abstract

Serious psychological distress (SPD) is associated with high healthcare utilization, expenditures, and low satisfaction. At the same time, evidence suggests that having a usual source of care (USC) is associated with lower and appropriate health services use, lower healthcare expenditures, and higher satisfaction. These effects of USC have not been evaluated in individuals with psychological distress, who have distinct characteristics like healthcare avoidance and mistrust that could affect this relationship. So, we examined the relationships between USC and healthcare utilization, expenditures, and satisfaction in individuals with SPD using a national representative dataset.Panels 10-17 of the Medical Expenditure Panel Survey (MEPS) were used to examine these relationships. We performed a propensity score analysis and used the results to adjust our analyses. The relationships between USC and healthcare utilization patterns were analyzed using Zero-Inflated Negative Binomial (ZINB) models. Multivariable linear and logistic regressions were used to analyze the relationships between USC and healthcare expenditures and satisfaction, respectively.After adjusting for potential confounding factors, we found that USC is associated with a lower frequency of hospital admission but a higher frequency of home health visits. We also found that USC is associated with an increased likelihood of having at least one hospital outpatient or office-based provider visit a year. This could be beneficial since those settings are common places for receiving annual preventive services. Finally, we recommended that researchers further explore our research questions in-depth, and policymakers should use our results to guide them in making decisions regarding healthcare interventions targeted at increasing USC for individuals with psychological distress.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest

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