The influence of affordability and Affordable Care Act on patients' and veterans' healthcare-seeking behaviors and access to healthcare.

Abstract

As legislative actions, such as the Affordable Care Act, and technological innovations have increasingly looked to provide improved healthcare delivery in the United States (US), the desire for quality of life, overall health, and, notably, patient access to healthcare has become extremely important in people’s lives. Building on path dependency theory, agency theory, and prior healthcare access research, this dissertation provides a research model of patient access by postulating and empirically validating the factors associated with patients seeking healthcare. Essay 1 focuses on understanding patient behaviors when seeking healthcare in distinct periods before and after the Patient Protection and Affordable Care Act (PPACA). I conduct four separate analyses of secondary data using binary logistic regression of the National Health Interview Survey (NHIS) to understand whether there are differences in healthcare-seeking choices before and after legislation shifts. The research model is tested using secondary data from the NHIS for 2016–2019. The findings reveal the differences in patients’ choices regarding patient access across the periods. In Essay 2, I draw upon agency theory, the strength of ties, and technology acceptance theories to test a research model of healthcare-seeking differences between veteran and nonveteran groups. Binary logistic regression is used, with patient access as the dependent variable and critical variables related to economic costs, social embeddedness, and technology access as independent variables. I theorize that veteran groups have stronger socially embedded ties and are more apt to use technology when seeking healthcare than nonveterans. Furthermore, I posit that age and gender impact health-seeking, such that younger persons have a demonstrably more significant impact on social embeddedness and the use of technology. The findings confirm the role of social embeddedness and technology use in seeking healthcare. Findings from this dissertation have important academic and practical implications for patient access to healthcare and veteran access to healthcare and help explain whether there are deficiencies in veterans accessing healthcare compared with nonveterans. Notably, the findings from this dissertation have practical significance to Department of Veteran Affairs healthcare decision-makers to help understand veteran preferences, areas for further exploration, and healthcare provision. Conclusions from this dissertation outline the need for further study into patient access to healthcare aspects that will increase access to healthcare and the use of healthcare by patients. One key recommendation is to understand better and encourage the use of technology and social embeddedness of patients to activate themselves in seeking solutions to their healthcare from healthcare providers.