title: Multigroup Path Analysis of the Influence of Healthcare Quality, by Different Health Insurance Types.
abstract: Winds of change have been blowing in the U.S. healthcare system since passage of the Affordable Care Act. Examining differences between individuals covered by different types of insurance is essential if healthcare executives are to develop new strategies in response to the emerging health insurance market. In this study, we used multigroup path analysis models to examine the moderating effects of health insurance on direct and indirect associations with general health status, satisfaction with received care, financial burden, and perceived value of the healthcare system. Data were obtained from the 2012 Medical Expenditure Panel Survey and analyzed according to the types of insurance: private, public, and military. With the satisfactory fit of the model (χ = 2,532.644, df = 96, p < .001; normed fit index = 0.943; incremental fit index = 0.945; comparative fit index = 0.957; root mean squared error of approximation = 0.044), higher healthcare quality was positively associated with better health status, greater satisfaction, and greater perceived value of the healthcare system in the three insurance groups. In addition, although all direct paths between health service quality and financial burden were not statistically significant, indirect effects were significant in all models through health status. Being married and earning higher incomes were also found to be strong predictors of better health status and health service quality. Efforts to improve the quality of health services are needed, which could contribute to a reduction in health disparities among insurance beneficiaries and result in less healthcare spending.
authors.affiliation: Yong-Rock Hong, Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions, University of Florida, Gainesville; and Derek Holcomb, PhD, associate professor, Michael Ballard, EdD, chair and professor, and Laurel Schwartz, DrPH, assistant professor, Department of Public Health in the College of Health Sciences, Eastern Kentucky University, Richmond.
authors.forename: Yong-Rock
authors.initials: YR
authors.lastname: Hong
authors.forename: Derek
authors.initials: D
authors.lastname: Holcomb
authors.forename: Michael
authors.initials: M
authors.lastname: Ballard
authors.forename: Laurel
authors.initials: L
authors.lastname: Schwartz
mesh_terms: D005102:Health Expenditures; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007348:Insurance, Health; D058991:Patient Protection and Affordable Care Act; D011787:Quality of Health Care; D014481:United States