Date of Award

Summer 8-13-2019

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Ike Solomon Okosun

Second Advisor

Kim Renee Ramsey-White

Abstract

INTRODUCTION: Research on the relationship between types of health insurance and health outcomes among overweight or obese youth is lacking in the literature. In the Unites States, 17% of youth ages 2-19 years have been identified as being overweight or obese. More than 90% of youth ages 0-18 years in the United States have health insurance. It is important to understand if there are any significant relationships between types of insurance and health outcomes. According to the Kaiser Family Foundation, 54% of youth have privately-funded health insurance and 37% have Medicaid insurance, which is government-funded. Medicaid insurance is associated with lower household income levels, while private health insurance is associated with higher household income levels.

AIM: The aim of this study was to explore the relationship between types of health insurance and health outcomes among overweight or obese youth ages 3-15 years. Specifically, this study sought to answer these questions in overweight or obese American youth: (a) Is there an association between health insurance coverage type and general health status? (b) Is there an association between health insurance coverage type and asthma prevalence? and (c) Is there an association between health insurance coverage type and healthcare setting mostly visited for healthcare services?

METHODS: This study used the 2012 National Health and Nutritional Examination Survey (NHANES) National Youth Fitness Survey (NNYFS) data. Survey responses were completed by the parents or legal guardians of the study group. The main independent variable was type of health insurance. The dependent variables were perceived general health, asthma, and healthcare setting mostly visited for healthcare services. Overall general health status for each child was reported by their parents as “excellent,” “very good,” “good,” “fair,” or “poor” in NHANES NNYFS 2012. Excellent, very good, and good general health were categorized as “good general health” for this study. Fair and poor general health were categorized as “not good general health general health” for this study. The data analyses of this study were completed with IBM Statistical Package for the Social Sciences (SPSS) 22.0 for Windows.

RESULTS: There were no statistically significant differences in overall general health and the prevalence asthma between overweight or obese youth enrolled in Medicaid insurance and enrolled in private health insurance. Participants with Medicaid insurance had statistically significant lower odds of going to a doctor’s office or HMO mostly for healthcare services, as opposed to the emergency department or urgent care services, compared to participants with private health insurance (OR=0.16; CI=0.098-0.260). There were no statistically significant differences in overall general health and visits mostly to a doctor’s office or HMO for healthcare services between overweight or obese participants enrolled in Medicaid insurance and enrolled in private insurance, after adjusting for the age, sex, race, and household income of participants as well as the age, sex, education level, and marital status of participants’ parents or legal household guardians. Participants with Medicaid insurance had a statistically significant greater adjusted odds of having asthma compared to participants with private health insurance (aOR=2.6; CI=1.180-5.577).

DISCUSSION: Though not statistically significant for every variable, overweight or obese youth enrolled in Medicaid insurance had worse health outcomes than those enrolled in private health insurance, as measured by perceived general health, asthma prevalence, and the healthcare setting they visit mostly for healthcare services. Further research is needed to determine why youth enrolled in Medicaid may not go to a doctor’s office or HMO more often for healthcare services compared those enrolled in private health insurance, as well as to better understand the relationship between other independent variables and type of health insurance, health outcomes, and healthcare.

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