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Hierarchies of risk: The longitudinal dynamics of family, work, welfare, and health insurance in low-income women's lives.

机译：风险等级：低收入妇女生活中家庭，工作，福利和健康保险的纵向动态。

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摘要

Low-income women are at particularly high risk of having no or inadequate insurance. Welfare reform has pushed more low-income women into the labor market but women's access to insurance has continued to erode. In addition, low-income women often experience work and family changes which affect their ability to access both private/employer-based and public insurance programs. We know continuity of coverage matters for women's health, but few have examined the role of individual-level health insurance instability in perpetuating low-income women's poverty. Cross-sectional analyses do not adequately reflect the dynamic nature of low-income women's lives and their lack of continuity in health insurance access.;The goal of this dissertation is to assess the role of individual-level welfare, work, and family changes in predicting low-income women's access to insurance and poverty over time in order to inform effective social policy. Specifically, I seek to answer the following research questions: (1) What is the relative importance of various welfare, work, and family changes in predicting low-income women's insurance coverage over time? (2) Given the diversity of low-income women's experiences, are there significant differences between categories of low-income women (such as the poor and near-poor) in the significance of these changes and women's access to insurance? And (3) given the effects of welfare, work, and family changes on low-income women's health insurance access, what role does health insurance stability play in determining changes in women's poverty status over time?;Results of the various statistical analyses provide consistent evidence of a hierarchy of risk among low-income women. For example, I find that low-income women who experience welfare, work, and family changes may have access to public and private forms of insurance, but compared to women with stable welfare, work, and family attachments low-income women who iv experience many changes over time simply do not fare as well and are at greater risk of being uninsured or having unmet health needs. I also find evidence that the significance of various welfare, work, and family factors varies by type of insurance examined. For instance, while stable marriage and work patterns may increase women's access to private forms of insurance while reducing their access to public forms of insurance, the same factors do not significantly predict women's risk of being uninsured. Nevertheless, this should not suggest that marriage and work patterns are unrelated to women's risk of being uninsured. Instead, I argue that such findings illustrate the complex effects of welfare, work, and family factors on women's access to various forms of health insurance; while some low-income women may benefit from access to marriage and work opportunities, others may find themselves at greater risk of lacking access to sufficient insurance. The complex and contradictory nature of these effects may make them difficult to model statistically but illustrate the importance of examining the nuances of low-income women's lives.;I also find evidence that certain factors may be more (or less) consequential for poor women than their near-poor peers. Such findings provide evidence of the differential strategies low-income women utilize in order to meet their health insurance needs -- poor women's reliance on public forms of health insurance creates different risks for them than their near-poor peers who are forced to rely on private forms of insurance to meet their health needs. Finally, I find some limited evidence that certain welfare, work, and family factors are indeed related to low-income women's movement into and out of poverty over time. I conclude by arguing that recent health care reforms have the potential to significantly improve low-income women's access to insurance, thereby altering the hierarchy of risks many low-income women face under the status quo.
机译：低收入妇女没有保险或保险不足的风险特别高。福利改革将更多的低收入妇女推向劳动力市场，但妇女获得保险的机会继续受到侵蚀。此外，低收入妇女经常经历工作和家庭变动，这会影响她们获得私人/雇主和公共保险计划的能力。我们知道承保范围的连续性对妇女的健康至关重要，但是很少有人研究过个人水平的医疗保险不稳定在使低收入妇女的贫困长期存在中的作用。横断面分析不能充分反映低收入妇女生活的动态性质以及她们在获得健康保险方面缺乏连续性。本论文的目的是评估个人水平的福利，工作和家庭变动的作用。预测低收入妇女随着时间的流逝获得保险和贫困的机会，以便为有效的社会政策提供信息。具体来说，我寻求回答以下研究问题：（1）在预测一段时间内低收入妇女的保险范围时，各种福利，工作和家庭变化的相对重要性是什么？ （2）鉴于低收入妇女经历的多样性，在低收入妇女类别（如贫穷和接近贫困）之间，这些变化的重要性和妇女获得保险的机会是否存在显着差异？ （3）考虑到福利，工作和家庭变化对低收入妇女获得健康保险的影响，健康保险的稳定性在确定妇女贫困状况随时间的变化中起什么作用？低收入妇女中风险等级的证据。例如，我发现经历过福利，工作和家庭变迁的低收入妇女可能会获得公共和私人形式的保险，但是与拥有稳定福利，工作和家庭依恋的妇女相比，经历过福利，工作和家庭变动的低收入妇女随着时间的流逝，许多变化根本就不会奏效，并且更容易遭受未保险或健康需求未得到满足的风险。我还发现有证据表明，各种福利，工作和家庭因素的重要性因所检查的保险类型而异。例如，虽然稳定的婚姻和工作方式可以增加妇女获得私人保险形式的机会，同时减少妇女获得公共保险形式的机会，但相同的因素并不能显着预测妇女没有投保的风险。但是，这并不意味着婚姻和工作方式与妇女没有保险的风险无关。相反，我认为这些发现说明了福利，工作和家庭因素对妇女获得各种形式的健康保险的复杂影响。虽然一些低收入妇女可能会从婚姻和工作机会中受益，但其他人可能会发现自己面临无法获得足够保险的更大风险。这些影响的复杂性和矛盾性可能使它们难以进行统计学建模，但说明了检查低收入妇女生活细微差别的重要性。我还发现有证据表明，某些因素对贫困妇女的影响可能大于（或小于）后果。他们的穷人。这些发现为低收入妇女满足其健康保险需求所采用的不同策略提供了证据-贫穷妇女对公共形式健康保险的依赖给她们带来了与被迫依赖私人的近乎贫穷的同龄人不同的风险。满足他们健康需求的保险形式。最后，我发现一些有限的证据表明，某些福利，工作和家庭因素的确与低收入妇女随着时间的推移摆脱贫困和摆脱贫困有关。最后，我认为最近的医疗保健改革有可能显着改善低收入妇女获得保险的可能性，从而改变许多低收入妇女在现状下面临的风险等级。

著录项

  • 作者

    Legerski, Elizabeth Miklya.;

  • 作者单位

    University of Kansas.;

  • 授予单位 University of Kansas.;
  • 学科 Sociology Social Structure and Development.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 216 p.
  • 总页数 216
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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