Electronic Theses and Dissertations

Date

2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Systems & Policy

Committee Chair

Aram Dobalian

Committee Member

Paige Powell

Committee Member

Meredith Ray

Committee Member

Courtnee Melton-Fant

Abstract

Access to healthcare services is impactful to health, and barriers to access can lead to disparities in health outcomes for different populations. Barriers to care can be financial and nonfinancial, and some populations may be more at risk for encountering barriers than others. As the American workforce is dynamic and heterogenous, understanding the different subgroups aids in understanding how to address their healthcare needs. This research aims to understand the impact employment structure, specifically the multiplicity of jobs, has on health and access to healthcare services. In addition, it aims to understand the effect of previous policy intervention on Multiple Job Holders (MJH) barriers to accessing healthcare services. Data from the National Health Insurance Survey (NHIS) was utilized for this research. The sample included those aged 18-64, working at least one job. This research explored the relationship between employment structure, specifically if someone is a single job holder or multiple job holder, and their actual health as well as their perceived sense of health through logistic regression analyses. It also explored the relationship between employment structure and experiencing barriers to care, both financial and operational. And finally, it explored whether there was a change in the experience of MJH with barriers to care pre- and post- ACA through a difference-in-difference analysis. This was done through a grouping of responses pre-ACA from 2005-2009, and post-ACA of 2013-2017, excluding three years for the implementation period. The analyses found that MJH had higher odds of reporting the presence of a health condition, as well as higher odds of reporting poorer health when compared to SJH. MJH also had slightly higher odds of reporting worsening health when compared to a year prior. In the examination of access barriers, MJH were found to have higher odds of experiencing both financial and operational barriers to care. Despite the efforts of the ACA to improve access to healthcare by increasing access to health insurance, there was no statistical difference in the reduction of the odds of experiencing health conditions post-ACA by MJH. This research fills a gap in the literature about MJH and their health outcomes and access to healthcare, but also has policy implications in regard to employer-sponsored health insurance as well as the future of the ACA.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest

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