Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Donald L. Alexander

Second Advisor

Dr. Jean Kimmel

Third Advisor

Dr. Jim Zhiming Li

Fourth Advisor

Dr. Donald Meyer


The impact of insurance type on health care is a very important topic in health economics. This dissertation examines the relationship between insurance type and health care cost, use and outpatient provider choice using the Medical Expenditure Panel Survey data. I examine separately three types of services: emergency, nonemergency hospital care and outpatient because the effect of insurance type on use may depend on the type of health care service provided. The insurance types analyzed are Health Maintenance Organization (HMO), private fee-for-service employer insurance, private fee-for-service non-employer insurance, government insurance and self insurance. For each service, individuals paying for health care out-of-pocket had the lowest cost and usage when compared to people insured by the other insurance types. They also used more hospital outpatient care than office outpatient care when compared to persons insured by the other insurance types. Individuals insured through private non-employer insurance had higher usage and the same cost per event when compared to those insured through private employer insurance, for both emergency and outpatient services. There is no significant difference in usage when comparing government insurance and HMO insurance with private employer and non-employer insurance. However both HMO and government insured persons had significantly lower costs when compared to fee-for-service insured persons.

Access Setting

Dissertation-Open Access