Document Type


Date of Degree

Fall 2011

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Urmie, Julie M.

First Committee Member

Doucette, William R.

Second Committee Member

Farris, Karen B.

Third Committee Member

Polgreen, Linnea A.

Fourth Committee Member

Sorofman, Bernard A.


Over six million insured children belong to families where the parents in their household lack health insurance. Studies have indicated insured low-income children with uninsured parents are less likely to have physician visits and well-child visits than their counterparts with insured parents. However, self-selection may be responsible for the relationship found between parental insurance and well-child visits. No studies have been undertaken to examine the impact of parental insurance on the utilization of children with chronic conditions. Social Cognitive Theory was used to model children's health care utilization and explain the relationship between parental insurance and that utilization. The objectives of the study are to estimate the effect of health insurance for the primary parent on (1) insured children's well-child visits and (2) physician visits for asthma in insured children.

This study used a cross-sectional design. The data source was the 2007 Medical Expenditure Panel Survey-Household Component. The sample consisted of children 17 years or less who were insured through the same source(s) for the entire year and had a primary parent who was either insured or uninsured the entire year. The dependent variable for the entire sample was whether or not the child had at least one well-child visit during the year. The dependent variables for the subsample of children with asthma were (1) whether or not the child had at least one asthma-related physician visit and (2) whether or not the child had at least two asthma-related physician visits. The independent variables were the same for the three analyses and were selected to represent the Social Cognitive Theory determinants. These included parent (insurance, sex, worry, education, language, employment, health use, health, risk aversion, and self care expectation), child (source of coverage, age, health, race, and oldest child), and household (Metropolitan Statistical Area, region, number of children, number of parents, and income) variables. Probit and bivariate probit models were estimated for each dependent variable. The percentage of children with insured parents that had a well-child visit during the year was significantly higher than the percentage of children with uninsured parents that had a well-child visit (50.6% vs. 42.8%, respectively). However, multivariate analyses revealed no significant relationship between parental insurance and well-child visits. The percentages of children with insured and uninsured parents that had an asthma-related physician visit were 29.6% and 32.6%, respectively. The percentages that had at least two asthma-related visits were 14.9% and 14.6%, respectively. No significant relationship was found between parental insurance and asthma-related physician visits. The region of the United States where the child lived and whether the child's parent was employed were associated with each type of utilization. Other determinants were also associated with children's utilization, but these varied with the type of utilization. In conclusion, insured children with insured parents are no more likely to have a well-child or asthma-related physician visit during the year than insured children with uninsured parents.


asthma, child, insurance, parent, utilization, well-child visit


xiv, 236 pages


Includes bibliographical references (pages 224-236).


Copyright 2011 Amber Goedken