The relationship of duration of time without health insurance to access and utilization of health care in the state of Kansas

Dissertation (Ph.D.)--University of Kansas, Nursing, 2007.Over 46 million people in the United States are currently without health insurance coverage, and 300,000 of those people reside in the state of Kansas. The lack of health insurance for all residents of the United States has long been debated in political, policy, and research circles. The prevailing thesis has been that people fall into one of two groups: (a) those with health insurance coverage and, (b) those without health insurance coverage. While this dichotomy is theoretically accurate, in reality there are very diverse subpopulations within each of these groups. Of interest in this study was the variation in population characteristics related to the length of time without health insurance coverage. The uninsured have been viewed historically as a homogenous population. The diversity among the uninsured has not previously been explored to determine the relationship among the length of time without insurance to health care access and utilization. Despite the many federal studies conducted to identify and describe the uninsured population, there is very little information available about the subpopulations of the uninsured. The purpose of this study was to explore the relationships among length of time without health insurance and access to health care, utilization of health care services, and demographic/socioeconomic variables in uninsured Kansans. A descriptive correlational design utilized a secondary data analysis of existing data collected from residents of Kansas who participated in the Kansas Health Insurance Study conducted in 2001. The total sample for analyses in this study included 19,082 subjects. Of those 19,082 subjects, 17,260 were insured and 1822 were uninsured. A series of six logistic regression procedures were conducted to determine the relationship between duration of time without health insurance to access, utilization of care, and demographic/socioeconomic variables. This study was able to determine differences in health care access, utilization and demographics of the uninsured population based on the length of time that they had been without health insurance coverage. The results of the study identified that variation exists among the subpopulations of the uninsured. As the length of time without health insurance increased the significant predictors also changed. Age was found to be significant for most of the logistic regressions. As age increased, the odds of being uninsured for a longer period of time also increased. Race was also found to be a significant factor. Self employment was found to be a significant factor in those uninsured for six months and under. At least one of the access variables was also significant in all of the uninsured periods. The results of this study have implications for nursing practice, nursing education, nursing research and most importantly for health policy. Diversity among the subpopulations of uninsured Kansans was identified. Future policy solutions that address the uninsured will need to target the diversity in order to be effective