Socio-economic and insurance factors in preventive care: A two-stage weighted structural analysis

Abstract

This study investigates the key determinants influencing the utilization of preventive health services among insured individuals in the United States following the implementation of the Affordable Care Act (ACA). Leveraging nationally representative data from the 2024 Financial Inclusion Survey, the research employs weighted logistic regression and Structural Equation Modeling (SEM) to analyze how perceived insurance coverage quality, access to a primary care physician, financial knowledge, and experiences with healthcare costs are associated with the uptake of no-cost preventive care. The findings reveal that individuals who report higher satisfaction with their insurance coverage, maintain ongoing relationships with primary care providers, and demonstrate greater financial literacy are more likely to engage in preventive health behaviors. Notably, while cost-related barriers are initially associated with increased utilization, their direct influence diminishes when financial knowledge is accounted for, highlighting the mitigating role of financial literacy. The SEM approach further clarifies the complex interplay between latent constructs such as perceived coverage quality and cost experiences, showing that these factors interact with each other and with other determinants to shape preventive care decisions. Importantly, once these structural and informational dimensions are considered, traditional demographic variables — such as race and gender — lose statistical significance, underscoring the greater impact of systemic and educational factors. These results suggest that policies aimed solely at eliminating financial barriers may be insufficient to maximize preventive care participation. Instead, fostering trust in insurance coverage, strengthening primary care relationships, and enhancing financial literacy are critical strategies for increasing preventive service utilization. By addressing the informational, relational, and economic dimensions of healthcare access, policymakers and stakeholders can more effectively promote preventive health engagement and advance population health outcomes.