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Open Access Publications from the University of California

An Examination of the Hawaiian Health System and Social Mobility

  • Author(s): Murray, Katherine Anne
  • Advisor(s): Thompson, Lisa
  • et al.

In light of the recent national roll out of the Affordable Care Act, which expands health insurance coverage to many Americans, we sought to evaluate the relationship between health insurance status and subjective social status among residents of Hawaii. Cross-sectional data from 738 residents of Hawaii were collected from nine community sites on the island of Hawaii via a verbally administered survey. This survey collected data about demographics, what the greatest health and social concerns are in Hawaii, and what the greatest strengths are of Hawaiian society. Participants were also asked to place themselves on a 10-rung ladder to assess their subjective social status, using the MacArthur Scale of Subjective Social Status. Frequencies and percents were calculated to describe perceived health and social problems. Multivariate linear regression was used to analyze the association between SSS (the dependent variable) and the primary independent variable (insurance status). Covariates were assessed using Student's t-test (ladder rank of SSS was normally distributed) or Chi-square test and included in the linear model if they were statistically related to the dependent or primary independent variable at p<.10 or found to be variables associated with SSS in the literature. In the final linear regression model, individuals with private insurance viewed themselves as higher on the ladder compared to those with Medicaid/Quest after controlling for age, education, and ethnicity. Those with greater than a high school degree also placed themselves significantly higher on the SSS ladder than those with a high school degree or less after controlling for health insurance, ethnicity, and age. Respondents between the ages of 27-64 years were lower on the SSS ladder than those 65 years or older after controlling for health insurance, ethnicity, and education. Future work should be done to evaluate what other variables affect subjective social status so that we can have a more robust understanding of how social capital influences the health of individuals within their communities.

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