A large body of research, typically nationally focused, has examined the relationship between family structure, educational attainment, and healthcare access. Within this field of study, there is limited availability of regionally based studies, specifically the Lower Mississippi Delta (LMD) region. This exploratory study examines the effects of family structure on high school graduation rates and health insurance coverage within the LMD region. The objective is to determine if family structure has a direct impact on the educational attainment and health outcomes of a child within the region using concepts from nationally focused literature. Through the use of an OLS regression, we find that family structure does not have a strong impact on the educational attainment of children within the region. However, we did find that family structure had a strong impact on the health insurance coverage of youth within the region. Additionally, we examine the impact that spatial location and race has on these variables. These results can encourage the development of potential intervention programs, outreach initiatives, and other programs geared toward helping youth within the region. The study's conclusions provide insight on the impact of family structure on health and education thus encouraging further research within the LDM region.

Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause "marriage lock," in which couples stay married for the sake of health insurance coverage, and marriage lock may change under the Affordable Care Act. In the first two chapters, marriage lock is examined in the context of two key health insurance decisions: divorce decisions upon qualification for Medicare at age 65, and marriage and divorce decisions associated with the introduction of the Massachusetts insurance mandate and health insurance exchange market reforms in 2006. In the first chapter, using the Health and Retirement Study data, I find evidence of a 7 percentage point increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. In the second chapter, using the American Community Survey data, I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchange market relative to control states. Specifically, the Massachusetts reform appears to have reduced the divorce rate by 0.5 percentage point and increased marriage rate by 1.4 percentage points. In the third chapter, I use data from the China Household Finance Survey (CHFS) to explore three decisions potentially affected by the implementation of Medical Savings Accounts (MSAs). First, I find that individuals with MSAs incur 17 RMB more medical expenses per 1000 RMB increase in their MSAs balance, while I find no significant effect of after-tax income on medical expenses. Second, I study preference heterogeneity as revealed by three types of risky behaviors. I find undertaking risky investments is associated with 23% more medical expenditures, while always using a seatbelt and obeying traffic signals are associated with 16% and 22% higher medical expenditures, respectively. Finally, I find evidence suggesting that individuals become more risk adverse with MSAs than without, specifically by increasing their use of seatbelts and obeying traffic signals. These findings, using recent Chinese data, suggest that MSAs play an important role when consumers make health expenditure decisions, and that preferences involving risk and prevention also appear to be influenced by the MSA scheme.

Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income <$20,000) is associated with the highest likelihood of being uninsured (37.3 %). As the result of this investigation, we observed the following relationship between drug use and lack of insurance: alcohol abuse/dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000–$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0969. Adviser: Charles E. Begley. Includes bibliographical references.

Cette thèse analyse l'émergence, en France, de la question du non-recours à la Couverture maladie universelle complémentaire (CMU C) et à l'Aide complémentaire santé (ACS), ainsi que son institutionnalisation dans la branche Maladie de la Sécurité sociale. La CMU C et l'ACS ont été créées pour limiter les inégalités d'accès aux soins. Celles-ci se sont en effet accrues avec les augmentations continues des frais de santé laissés à la charge des patients. Au croisement de la socio-histoire, de la sociologie de l'action publique et de la sociologie des organisations, le processus d'institutionnalisation du non-recours est étudié de manière chronologique, au travers de séquences d'action qui ont : initié une attention pour le phénomène ; positionné ses enjeux au regard des restructurations de la protection maladie des plus démunis ; construit des représentations et structuré une stratégie d'action pour le traiter. Principalement problématisé autour d'un enjeu d'effectivité des droits CMU C et ACS, le non-recours est devenu peu à peu un instrument opérationnel de la correction des inégalités d'accès aux soins, définie comme axe prioritaire de la gestion du risque maladie. Sa prise en compte a engagé l'Assurance maladie dans des changements profonds de pratiques et d'organisation du travail. De manière surplombante, c'est une transformation du rapport de l'institution à ses ressortissants fragiles qui s'est enclenchée, afin de faire en sorte que les populations démunies se rapprochent de leurs droits. En ce sens, l'institutionnalisation du non-recours s'inscrit dans un mouvement qui vise à concentrer les moyens et les actions de la branche Maladie sur les populations dites fragiles. Une approche de l'action publique par le non-recours aux droits paraît ainsi pertinente pour comprendre comment l'intégration de problèmes émergents, peu visibles ou volontairement ignorés, leur mise en sens par des acteurs publics et l'institution de nouvelles catégories d'action viennent travailler les organismes administratifs bureaucratiques dans leurs fonctionnements, leurs logiques et leurs normes d'intervention les plus ancrés. L'approche par le non recours est, en l'occurrence, un traceur du changement opéré à l'aune des ressortissants de l'action publique. / This thesis analyzes the emergence, in France, of the issue of non take-up of Free Supplementary Health Insurance Coverage (“Couverture maladie universelle complémentaire” or “CMU-C”) and Assistance for Private Health Insurance (“Aide complémentaire santé” or “ACS”), as well as its institutionalization within the Health branch of the Social Security system. The CMU-C and the ACS have been created to limit the inequalities in access to healthcare. These have indeed risen with the continuous increase of health expenses left payable by the patients. At the crossroads of socio-history, sociology of public action and sociology of organizations, the process of institutionalization of non take-up is studied chronologically, through sequences of action which have: brought to attention the phenomenon; positioned its challenges in light of the health care restructurings for the most destitute; built representations and structured a plan of action to treat it. Problematized primarily around the challenge of operativity of the CMU-C and ACS benefits, the non take-up has gradually become an operational tool for the correction of inequalities in access to healthcare, which was defined as a priority in the management of health issues. Addressing it has committed the health system to profound changes in its practices and work organization. Overarching it, a transformation of the institution's relationship to its vulnerable nationals has been set into motion, to ensure that the destitute populations are brought closer to their benefits. In this respect, the institutionalization of non take-up is part of a movement that seeks to concentrate the resources and actions of the Health branch on the populations considered vulnerable. An approach of public action by the non take-up of benefits thus appears relevant for understanding how the integration of emerging problems, less visible or deliberately ignored, their sensegiving by public actors and the institution of new categories of action, come to challenge the bureaucratic administrations in their most entrenched functioning, logic and standards of intervention. The approach by the non take-up is, as it happens, an indicator of change operated with regard to public action beneficiaries.