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The Role of Race, Place, and Social Determinants of Health in Disparate Utilization of Pediatric Preventive Care Services in a Medicaid Population

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 (Unpublished)

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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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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Raslevich, Amy Christineamy.raslevich@pitt.eduacr590000000333149808
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue, Juliejdonohue@pitt.edujdonohue0000000324186017
Committee MemberGary-Webb, Tiffanytgary@pitt.edutgary
Committee MemberOhmer, Marymlo51@pitt.edumlo510000000196865938
Committee MemberRay, Kristinkristin.ray@chp.edu0000000338171449
Committee MemberYouk, Adaayouk@pitt.eduayouk0000000169129759
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


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