Raslevich, Amy Christine
(2023)
The Role of Race, Place, and Social Determinants of Health in Disparate Utilization of Pediatric Preventive Care Services in a Medicaid Population.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Pediatric well-child visits are especially important in childhood and have been associated with rates of hospitalizations, emergency department visits and sick visits. Though the services are nearly universally paid for by health insurance, there are significant racial disparities in the utilization of these services between Black and White Children. Much of this gap is likely driven by differences between enrollees in economics, education and environment, differences that are inextricably linked to our nation’s history of racism and discrimination.
This dissertation explores factors associated with disparities in the utilization of pediatric preventive services between Black and White children in the Pennsylvania Medicaid managed care program. Chapter 1 uses decomposition methodology to analyze what local area socio-economic factors are most associated with the disparity statewide, incorporating a comprehensive index measure of child opportunity in ZIP codes across the Commonwealth. This method explains almost 15% of the statewide disparity. Chapter 2 uses the same methodology but focuses on those children who live in ZIP codes that were graded by the U.S. government for mortgage risk in the 1930s, a program resulting in ratings that influence conditions and investments in those communities even today. The gap between Black and White use is much wider in this exclusively urban population, and the analytic model explains almost 25% of the difference. Chapter 3 attempts to reflect the experiences and perceptions of Black parents in Allegheny County, the second largest in the state, whose children are enrolled in Medicaid and who must make the decisions on whether, when, and how their children receive preventive services. By centering their voices and reflections along with the modeled approach of the two quantitative analyses, policies can be developed that are informed and nuanced in complementary ways, allowing for more efficient and effective strategy development and resource deployment.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
3 January 2023 |
| Date Type: |
Publication |
| Defense Date: |
12 December 2022 |
| Approval Date: |
3 January 2023 |
| Submission Date: |
30 November 2022 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
160 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Health Policy & Management |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Medicaid decomposition disparity preventive pediatric |
| Date Deposited: |
03 Jan 2023 15:23 |
| Last Modified: |
03 Jan 2023 15:23 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/43912 |
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