Ability to Obtain Medical Care for the Uninsured

Abstract

Context.-Communities differ in the way that medical care for medically indigent persons is organized and delivered, which is likely to result in differences across communities in the ability of uninsured persons to obtain medical care. Changes in the health care system, many of which are driven locally, may further exacerbate these differences. Objective.-To examine the extent of variation across US communities in the ability of uninsured persons to obtain medical care and the extent to which health status and other characteristics of the uninsured population account for these differences. Design.-Analysis of the 1996-1997 Community Tracking Study Household Survey. Setting.-A nationally representative sample of the US civilian, noninstitutionalized population residing in 60 randomly selected communities. Larger sample sizes were obtained for 12 of these communities, which were randomly selected to represent metropolitan areas in the United States with more than 200 000 persons. Participants.-A total of 60 446 individuals and 7200 uninsured persons. Main Outcome Measures.-The percentage of persons who either did not obtain needed medical care in the previous year or postponed receiving needed medical care in the previous year. Results.-Differences between communities with the highest percentage of uninsured persons reporting difficulty obtaining care and communities with the lowest percentage were more than 2-fold (41.4% vs 18.5%, PϽ.05). Little of the variation across communities is accounted for by differences in health status or sociodemographic characteristics of the uninsured population. The pattern of variation across communities in the ability of uninsured persons to obtain medical care is not correlated with variations in the ability of privately insured persons to obtain care (Pearson r, 0.04). Simulation results indicate that expanding private or public insurance coverage would not only increase the ability of uninsured persons to obtain medical care but would also reduce the variation across communities. Conclusions.-If people are uninsured, where they live is an important factor in determining the difficulty they have in obtaining care. This is likely to persist given that care for uninsured persons is driven largely by state and local policy, and health system changes are constraining clinicians' ability and willingness to serve uninsured persons in many parts of the country.

Health care utilization and costs among medical-aid enrollees, the poor not enrolled in medical-aid, and the near poor in South Korea

“…This is similar to previous studies that reported higher levels of unmet need and lower rates of health care utilization for low income people compared to middle to high income people [16, 17, 18, 19, 20]. And, indeed, this is borne out, with these US studies identifying uninsured and low income as two of the strongest correlates of unmet need [21–23, 24, 25, 26, 27, 28, 29–31, 32]. In countries with universal health care coverage, such as UK, Germany, and Canada, research on unmet need has been less extensive than in the United States, perhaps because of the relative lack of direct cost-based barriers to care.…”

Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

“…Our results also suggest an asymmetrical relationship between ER and office-based visits-a physician visit appears to diminish the probability of a later ER visit-while ER visits may result in a referral to a physician for follow-up care. For the urban uninsured, we confirm and extend earlier work (Cunningham and Kemper 1998) reporting lower access to care among the urban uninsured living in areas where managed care penetration is high.…”

“…Previous research has documented wide variation in access to medical care among uninsured individuals living in different communities (Cunningham et al 1998) and various studies have linked these access differences to variation across areas in managed care penetration, the percent of the local population that is uninsured, safety net capacity, and the location of safety net providers (Long and Marquis 1999;Cunningham 1999;Cunningham 2004a, 2004b;Cunningham and Hadley, 2004). …”

The Relationship Between County-Level Contextual Characteristics and Use of Diabetes Care Services

“…For instance, a study analyzing the Community Tracking Study Household Survey data found that uninsured persons living in communities with the highest percentage of uninsured persons were 2 times more likely to report difficulties in obtaining care. 29 While personal health insurance is an important enabling factor for access to care, our results indicate that, at the contextual level, the overall health insurance coverage rate in a community was an important enabling factor for preventive diabetes care services. This finding may reflect the need for health care delivery organizations to encourage and coordinate use of preventive diabetes care services.…”