Determinants of health outcomes and healthcare utilization
Murasko, Jason Elliot
Doctor of Philosophy
This thesis examines several issues concerning health outcomes and healthcare utilization. In the first chapter, I examine the relationship between health and human capital development in childhood and key adult outcomes---educational attainment and adult health status---using longitudinal data from the 1970 British Birth Cohort. I use robust measures of human capital in childhood including cognitive skill and so-called psychological capital and establish their effects on both educational attainment and adult health. Certain measures of health in childhood are also shown to affect these adult outcomes. I establish a relationship between parental socioeconomic status and the development of childhood health and human capital and discuss the implications for the inter-generational transmission of socioeconomic status and its effect on adult health. The second chapter uses the 1997 Medical Expenditure Panel Survey to examine the relationship between family income, insurance status, and chronic conditions in children and how these are associated with healthcare utilization. I find that while income is positively associated with some forms of utilization, there is no evidence of a differential effect for chronically-ill children. Insurance status---defined as private, public, or no insurance---does exhibit stronger associations with healthcare utilization for children with chronic conditions. I also present mixed evidence on the association between healthcare utilization and health outcomes. Finally, the third chapter focuses on the relationship between work characteristics and the utilization for a number of preventive and screening health services. I find that some work characteristics---including wage levels, paid sick leave, and retirement benefits---are positively related to utilization. Other characteristics---such as hours worked, irregular shifts, and working more than one job---are not significantly associated with use. I relate these findings to a conceptual framework in which time costs are important to the decision to use preventive services.