Lack of health insurance is a significant public health concern in the U.S. Currently more than 45 million Americans do not have any health insurance, and many more are underinsured. Public policy approaches that seek to improve access to medical care for the uninsured and underinsured must be based on an understanding of physician decision-making because physicians are gatekeepers who play an important role in determining the quantity and quality of medical care. This dissertation explores the relationship between physician variables (job satisfaction, decision-making style, social distance and length of time in practice), patient variables (insurance status, race, and ethnicity) and treatment recommendations by physicians for insured and uninsured patients. Survey instruments measuring social distance, job satisfaction, and tacit decision-making were mailed to a random sample of 250 Georgia family physicians. Decision outcomes were measured through the use of four vignettes that depict common, hypothetical scenarios requiring clinical decision-making. The vignettes varied only in the depiction of the patients described as in terms of insurance status, race, and ethnicity. The data indicated that in three of four hypothetical scenarios, physicians' clinical decisions varied depending on combinations of patient characteristics. The data also revealed that lack of health insurance (but not African American race or Latino ethnicity) resulted in lower decision outcome scores. No relationship was found between the set of physician variables (job satisfaction, decision-making style, social distance, and time in practice) and decision outcome scores. Decision-making style was negatively associated with decision outcome in Scenario 1. Time in practice was positively associated with decision outcome in Scenario 2. Time in practice was positively associated with job satisfaction. This study has important implications for health care policy in developing an effective response to the problem of medical indigence. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2006. / March 14, 2006. / Inequality, Access, Medical Care, Social Work, Public Health, Health, Indigent, Health Insurance, Decisions, Physicians, Prejudice, Stereotypes, Health Policy, Health Care Administration, Medical Sociology, Disparities In Health Care, Equity, Race, Ethnicity, Family Physicians, Georgia / Includes bibliographical references. / C. Aaron McNeece, Professor Directing Dissertation; Mary Ellen Guy, Outside Committee Member; Wendy Crook, Committee Member.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_181865 |
| Contributors | Cleeland, Robin Naugher (authoraut), McNeece, C. Aaron (professor directing dissertation), Guy, Mary Ellen (outside committee member), Crook, Wendy (committee member), College of Social Work (degree granting department), Florida State University (degree granting institution) |
| Publisher | Florida State University, Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text |
| Format | 1 online resource, computer, application/pdf |
| Rights | This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). The copyright in theses and dissertations completed at Florida State University is held by the students who author them. |
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