Date of Award


Document Type


Degree Name

Master of Science (MS)


Sociology, Anthropology and Criminal Justice

Committee Member

Dr. William Haller, Committee Chair

Committee Member

Dr. Veronica Parker

Committee Member

Dr. Kenneth Robinson

Committee Member

Dr. Brenda Vander Mey


Background: The Patient Protection and Affordable Care Act (ACA) made a tremendous impact on the nation’s nonelderly (ages 18-64) uninsured population. Despite the ACA provisions, they fell short of universal health insurance coverage; especially in states that chose not to expand Medicaid, like South Carolina. Those left uninsured are likely to experience great difficulty with the health care delivery system, especially in areas that have a high concentration of uninsured residents. Purpose: To assess the effect of psychological vulnerability, as measured by mentally unhealthy days, on access to healthcare and healthcare utilization among the long term uninsured in South Carolina. Methodology: Chi square, Spearman correlations, and regression analyses were run between mentally unhealthy days and questions relating to access to healthcare and healthcare services utilization. Results: Access questions that were found to have a statistically significant relationship to mentally unhealthy days: usual source of care, means of transportation to care, difficulty to receive care, amount of time taken to get to care, amount of time since last doctor’s visit, delay receiving care because of cost, and inability to get a necessary prescription. Utilization questions that were found to have a statistically significant relationship to mentally unhealthy days: time since last check-up, amount of time spent on healthcare within the last year, hospitalized in last twelve months, and emergency room visit in last twelve months. Discussion/Conclusion: Results show an overall lesser degree of fit between the health care system in the hotspots and the individuals residing in the area. Ultimately, psychological vulnerability is a significant factor relating to access to healthcare service, which subsequently translates into the adverse relationship between healthcare service utilization and mentally unhealthy days. Based on these results, it is imperative that policy makers consider how policy will influence the community uninsurance rates and the resources that the community will have available for its members.



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