Social stratification and the healthcare safety net
by Ko, Michelle, Ph.D., UNIVERSITY OF CALIFORNIA, LOS ANGELES, 2012, 129 pages; 3522819

Abstract:

Social inequalities can produce disparities in healthcare access and quality. This dissertation explores relationships between two social stratification processes- community residential segregation and social capital- on the supply of U.S. urban safety net providers.

The first paper, "Community residential segregation and the local supply of Federally Qualified Health Centers," used data from the Area Resource File and the U.S. Census to examine growth in FQHCs in urban counties from 2000 to 2007. Residential segregation by poverty and race/ethnicity were measured using the dissimilarity index. Logistic and negative binomial regression models were used for dichotomous and count outcomes, respectively. Residential segregation measures were associated with both county FQHC supply at baseline and the addition of new FQHCs over time. Residential segregation may produce geographic segregation of health services, such that FQHCs may be required to fill the gaps arising from provider maldistribution.

The second paper, "Residential segregation and the survival of U.S. urban public hospitals," used data from the American Hospital Association Annual Survey from 1987 to 2007. Cox proportional hazards models were used to estimate competing risks of hospital closure versus privatization. Poverty rates, intermediate poverty segregation, a low proportion of black residents, and low black residential segregation were associated with closure. Poverty associations suggest that areas with a high need for safety net services may be at risk to lose them, but segregated black communities may successfully advocate for maintenance of public hospitals. In contrast, Hispanic residential segregation was associated with privatization. Areas with segregated Hispanic communities may be less inclined to support public provision of services and have reduced opposition to privatization.

The third paper analyzed the same sample of urban public hospitals in relation to measures of community social capital. Voting rates were associated with closure, whereas bridging social capital among elites was associated with privatization. The findings suggest that social capital among privileged groups bears more influence on public hospital outcomes than vertical connections between the disadvantaged and those in power.

Taken together, the three papers suggest that social determinants may dictate both the need and societal response for the safety net.

 
AdviserNinez A. Ponce
SchoolUNIVERSITY OF CALIFORNIA, LOS ANGELES
SourceDAI/B 74-01(E), Sep 2012
Source TypeDissertation
SubjectsPublic health; Public policy; Health care management
Publication Number3522819
Adobe PDF Access the complete dissertation:
 

» Find an electronic copy at your library.
  Use the link below to access a full citation record of this graduate work:
  http://gateway.proquest.com/openurl%3furl_ver=Z39.88-2004%26res_dat=xri:pqdiss%26rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation%26rft_dat=xri:pqdiss:3522819
  If your library subscribes to the ProQuest Dissertations & Theses (PQDT) database, you may be entitled to a free electronic version of this graduate work. If not, you will have the option to purchase one, and access a 24 page preview for free (if available).

About ProQuest Dissertations & Theses
With over 2.3 million records, the ProQuest Dissertations & Theses (PQDT) database is the most comprehensive collection of dissertations and theses in the world. It is the database of record for graduate research.

The database includes citations of graduate works ranging from the first U.S. dissertation, accepted in 1861, to those accepted as recently as last semester. Of the 2.3 million graduate works included in the database, ProQuest offers more than 1.9 million in full text formats. Of those, over 860,000 are available in PDF format. More than 60,000 dissertations and theses are added to the database each year.

If you have questions, please feel free to visit the ProQuest Web site - http://www.proquest.com - or call ProQuest Hotline Customer Support at 1-800-521-3042.