This thesis is comprised of three chapters that empirically examine two important areas in health economics: access to health care and health outcomes. The first chapter explores the impact of health care utilization on unmet health care needs (UHC) using four biennial confidential master files (2001-2010) of the Canadian Community Health Survey and applying an instrumental variables (IV) approach to deal with the endogeneity of health care utilization. The presence of drug insurance and the number of physicians in each health region are used to identify the causal effect. I find a clear and robustly negative relationship between health care use and unmet health care needs; individuals who are more likely to report unmet health care needs are those who use the health care system less frequently. One more visit to a family doctor, specialist or a medical doctor on average, decreases the probability of having unmet health care needs by 7.1, 4.6 and 2.8 percentage points, respectively. Further analysis by sub groups reveals that the impact of health care utilization on UHC is larger for females in comparison to males, rural residents in comparison to urban dwellers and those with low household income rather than high. The second chapter of this thesis examines whether the presence of the unmet health-care (UHC) needs has an adverse effect on health outcomes using the National Population Health Survey, a nationally representative longitudinal data set spanning 18 years. I pay close attention to the potential endogeneity of this problem. Five direct and indirect measures of health-related outcomes are examined. I find clear and robust evidence that the presence of UHC either two-years previously or anytime in the past, affects negatively the current health of the individual – controlling for a host of other influences. For instance, reporting UHC in the previous cycle reduces the probability of being in excellent or very good health and in good mental health, respectively by 8.1 and 1.2 percentage points; it reduces the HUI3 score by 2.9 percentage points and increases the expected number of medications used by 11%. Further analysis by looking at the effect of UHC when it was due to accessibility reasons, reveal that the effect of UHC because of accessibility reasons on health outcomes is larger than the one of the overall UHC, but the difference is small in general. Finally, the third chapter of this thesis examines the link between social networks and access to health care utilization, focusing particularly on the probability of having a regular family doctor. Unlike previous work that uses cross sectional data, I use panel data from the National Population Health survey to control for unobserved heterogeneity. Access to a regular family doctor is modeled using the dynamic random effects probit model, which makes it possible to explore the dynamics of access to a regular family doctor– for instance, the role played by past access status to a family doctor in predicting current access. In particular, I use the dynamic random effects probit model that controls for both unobserved heterogeneity and for initial conditions effects. I find robust evidence of a highly statistically significant relationship between social capital and the probability of having a regular family doctor. Although the marginal effects are modest, the results from all model specifications show that there is clear evidence that individuals with high levels of tangible, affection, emotional, social interaction, who live with spouse only or with spouse and children are more likely to have a regular family doctor, whereas those living alone are less likely to have a regular family doctor. The results also reveal that past access to a family doctor is an important determinant for both current and future access. The predicted probability of having a regular family doctor is about 18 percentage points (or 20%) higher for individuals who had a family doctor in the previous period, relative to those who did not. In addition, I find that unobserved heterogeneity accounts for about 25% of the variation in accessing a regular family doctor and is significantly correlated with the access to a family doctor over my long panel.

This dissertation focuses on the health, health care utilization rates, and unmet health care needs of individuals aging with work-related impairments. A life course perspective is used to understand the health experiences of these individuals, and a mixed method approach was used to study their health and health care use. Three components make up the dissertation, two quantitative projects and one qualitative project. The first article provides a broad overview of chronic health conditions reported by respondents from the Research Action Alliance on the Consequences of Work Injury (RAACWI) Health and Health Care Utilization Survey who experienced a work-related impairment. Health outcomes and access to health care for this group is compared to a similar aged sample of Ontarian respondents from the Canadian Community Health Survey. The second article uses the National Population Health Survey to examine whether rates of unmet health care needs over eight cycles varied based on disability status. Respondents are categorized as either without disability, having a work-related disability, having a disability as a result of a disease or illness, or having disability for other reasons. The reasons for unmet health care needs is examined for seven cycles to determine whether unmet health care need could be characterized as personal or structural. The third article provides a deeper understanding of how 11 individuals age with a work injury. A convenience sample of 11 participants from the RAACWI Health Survey participated in semi-structured, in-depth interviews where they discussed their work injury and how they are coping with its ongoing consequences, including subsequent health problems as they age. This article provides a richer understanding of health changes and unmet health care needs that could not be examined in the other projects due to the nature of quantitative analysis. Together these three articles enable me to showcase the lived experiences of individuals with work-related impairments and how they age with the work injury and subsequent, additional chronic health conditions. / Dissertation / Candidate in Philosophy