AN EMPIRICAL EXAMINATION OF THE RELATIONSHIP BETWEEN ACCESS TO CARE AND POPULATION HEALTH

Of the thirty-four OECD countries, the United States is one of just three that does not have a universal health care system. There are approximately 49 million Americans who do not have health care insurance and millions more who are underinsured, lacking adequate insurance coverage. The recent passage of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA), together commonly known simply as the Affordable Care Act (ACA) aims to change this by, among other actions, extending health care coverage to millions of people who could not otherwise afford it. There are numerous ways in which access to care can be defined such as the financial ability to obtain health services, even if the financing is covered by a third-party payer such as a health insurance company or subsidized by the government. In this regard, the ACA will improve access to care by providing approximately 32 million uninsured people the ability to obtain health insurance in coming years. However, this prompts the question of whether access to care actually improves the health of a population. This dissertation addresses this question in several ways. First, I describe the numerous ways in which both access to care and population health have been defined in other studies, and then provide a unique conceptualization for both terms. This is followed by three separate studies to examine the relationship between access to care and population health. The first study is a broad nationwide examination of the general association between access to care and population health within the U.S. This is followed by a second national study that focuses on rural populations. This second study will assess whether the federal program that authorized the development of Critical Access Hospitals (CAH) - a program designed to keep rural hospitals which meet stringent criteria solvent, in addition to attract physicians to rural areas through enhanced Medicare reimbursements - has been successful in recruiting physicians to rural areas and is associated with improving the health of the populations living in rural areas. Finally, the third study narrows the focus further by examining the impact that a single state program designed to expand access to health care, Wisconsin's BadgerCare Plus, has had on the health of its population. The findings of the three studies in this dissertation indicate that there is indeed a relationship between access to care and the health of the population. However, the manner in which access to care and health are defined will influence the findings of any study examining the relationship between the two. Furthermore, the strength of this relationship varies from locale to locale indicating that uniform nationwide measures to improve the health of the population through access to care are likely to result in differing outcomes around the country.