Doctor of Philosophy (PhD)


Social Work

Document Type



As the population of older adults in the U.S. continues its exponential growth, so too will the need for high-quality health and preventive services. Despite the widely acknowledged need for proactive solutions to the coming public health challenges for this rapidly expanding age cohort, healthcare providers and social work practitioners continue to lack the proper education training to serve the needs of older adults. Furthermore, these allied health professionals also frequently engage in ageist behaviors across care settings that also often employ institutionally ageist policies and procedures. As a result, older adults may be particularly at risk of negative health outcomes compared to younger individuals despite their insurance coverage rates of nearly 100%. While previous studies of insurance type and health outcomes have shown that Medicaid recipients tend to receive less and lower quality care compared to others, older adults have been generally excluded from these studies. Thus, this dissertation study aimed to address this gap in literature by conducting a study of the influence of insurance coverage type on 13 healthcare utilization and health behavior outcomes among adults 65 and older. Using the 2014 wave of the Health and Retirement Study, this cross-sectional, secondary data analysis utilized logistic regression and multiple regression to model each of the 13 outcomes using Andersen’s behavioral model. Results showed that insurance type was a significant predictor of three health services and four health behaviors: doctor visits, prescription drug usage, outpatient surgery, mild physical activity, moderate physical activity, cholesterol screening receipt, and flu vaccination receipt. Implications for social work practice, policy, Andersen’s behavioral model, and future research are discussed in light of the findings.



Committee Chair

Wilks, Scott