The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related to insurance status on the one hand and self-rated health on the other; whether the association between income and self-rated health is indirectly influenced by the presence of health insurance –namely private health insurance; whether there are differences in self-rated health between the privately insured, the publicly insured, and the uninsured; and if duration of uninsurance was inversely associated with self-rated health. As hypothesized, higher income was associated with having health insurance, and in particular private insurance. Among all included predictor variables, higher income and private insurance are the strongest predictors of higher self-rated health, and lower income and Medicaid were the strongest predictors of lower self-rated health. This study affirms that the health of persons with Medicaid is more similar to persons who are uninsured, and the health of persons with private insurance is more similar to those with Medicare. The association between income and self-rated health is indirectly influenced by health insurance. Age and education exerted the strongest overall influence on self-rated health: older respondents had lower self-rated health, and more educated respondents had higher self-rated health. And as uninsurance duration increased, self-rated health decreased. Additional studies are recommended to improve health insurance policy.


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Graduation Date





Unruh, Lynn


Doctor of Philosophy (Ph.D.)


College of Community Innovation and Education

Degree Program

Public Affairs; Health Services Management and Research









Release Date

December 2019

Length of Campus-only Access

1 year

Access Status

Doctoral Dissertation (Open Access)