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Since the late 1990s accelerated growth in health care spending coupled with a cost shift of health insurance from employers to employees has created an increased financial burden for many families. Past research suggests that financial burden due to out-of-pocket (OOP) health care costs limits access to health care and may reduce spending on other basic needs, such as food. The primary objective of this study was to assess the relationship between out-of-pocket health care expenditures and food insecurity among families with children. Secondarily, this study examined the relationship between the health status of children and household food security. This study used data from the Panel Study of Income Dynamics (PSID, 2003) to test whether higher out of pocket health care expenditures increase household food insecurity for families with children. Respondents reported out of pocket expenditures for both medical services and insurance premiums in 2001 and 2002. Food insecurity was measured for the previous 12 months using the 18-item USDA Food Security Survey Module. Multivariate weighted logit analysis was conducted to model the relationship between OOP health care costs and household food security status; and child health status and household food security. There was no evidence that higher OOP health care costs were associated with household food insecurity. However, among families earning less than 300 percent of the federal poverty threshold, having private insurance did increase the likelihood of experiencing food insecurity (OR =4.77, 95% CI = 0.05 - 1.02). Households with a child in poor health were not more likely to experience food insecurity; however having a wife in poor health was associated with food insecurity (OR = 4.00, 95% CI =1.67-9.52). The findings from this study suggest that programs designed to limit OOP health care spending among moderate and low income families should evaluate the impact on household food security. / Graduation date: 2013 / Access restricted to the OSU Community at author's request from July 23, 2012 - July 23, 2013

The purpose of this study is to demonstrate that within the United States health care system, a number of institutions have evolved which have given rise to a perverse set of incentives that direct technological change. As a result of these incentives, the diffusion and utilization of new and existing technologies is carried out in a random and indiscrete fashion, subsequently placing upward pressure on the costs of health care. This analysis relies on the empirical work, observations, and writings of a large number of physicians, social scientists, hospital administrators, and federal bureaucrats.

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