Hearing health care in the United States: A multi-scale spatial & political economic analysis of health care policy and access to audiology services

Planey, Arrianna Marie

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https://hdl.handle.net/2142/108257 Copy

Description

Title

Hearing health care in the United States: A multi-scale spatial & political economic analysis of health care policy and access to audiology services

Author(s)

Planey, Arrianna Marie

Issue Date

2020-04-27

Director of Research (if dissertation) or Advisor (if thesis)

McLafferty, Sara L

Doctoral Committee Chair(s)

McLafferty, Sara L

Committee Member(s)

• Wilson, David
• Cidell, Julie
• Rosenberg, Mark

Department of Study

Geography & Geographic InfoSci

Discipline

Geography

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• healthcare access
• audiology

Abstract

This project addresses hearing health care workers (audiologists) in the United States and the ways that structural, top-down pressures shape their spatial behavior and practice, which cumulatively affects the availability and accessibility of their services at multiple scales. Hearing loss is the third most prevalent disability in the United States, affecting 20 percent of the U.S. population and nearly half of older adults (≥75) (Agrawal, Platz, and Niparko, 2009). Moreover, despite the rising prevalence of hearing loss as the population ages, access to hearing health care services is sharply constrained by economic and geographical barriers and inequalities. The services to diagnose and treat hearing loss⁠—audiology services⁠—are not covered under most insurance plans, nor are they covered beyond a physician-referred assessment under Medicare; moreover, coverage of audiological services for adults under Medicaid varies state-by-state (Arnold, Hyer and Chisholm, 2017; Center for Medicare and Medicaid Services, 2016). Elderly and disabled people experience the effects of these limitations most acutely, due to their lower average household incomes and higher prevalence of hearing loss compared with the general population (Jung and Bhattacharyya, 2012). Therefore, this project examines audiologists, focusing on how their scope of practice and autonomy as professionals are constrained by health policy at the federal and state levels and the broader political economy of inter-professional practice in health care, all of which hinge on the classification of audiologists as non-medical “non-physician” care providers. Subsequent structural factors, such as low reimbursement rates and low professional autonomy, may influence the spatial behavior of audiologists, shaping tendencies in where they choose to locate, thus shaping the accessibility of their services. Situated in the context of an aging national population with growing hearing loss prevalence, this project also examines consumer access to hearing healthcare in the absence of comprehensive commercial insurance, Medicare, and Medicaid coverage of audiology services and hearing prosthetics/devices, which results from the path dependence of a health system formulated to address the needs of a young and ‘working age’ population. Employing GIS, spatial epidemiological, and spatial analytic methodologies, I examine the spatial, structural, and behavioral dimensions of hearing healthcare access on the part of providers and consumers.

Graduation Semester

2020-05

Type of Resource

Thesis

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http://hdl.handle.net/2142/108257

Copyright and License Information

Copyright 2020 Arrianna Marie Planey

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