Healthcare Markets, the Safety Net, and Access to Care Among the Uninsured
- Presenter:
Chair: Joel Hay; Discussant: TBA Tue June 6, 2006 8:00-9:30 Room 213
Research Objective : We use nationally representative data including observations on more than 8,000 uninsured adults to provide new insight into the relationship between access to care and not only the structure and capacity of the safety net but also the healthcare market more generally.
Study Design: We use Medical Expenditure Panel Survey (MEPS) data linked with data from multiple secondary sources. To describe the healthcare safety net and market structure in each individual’s location, we derive variables from the American Hospital Association Annual Survey of Hospitals, Area Resource File, the InterStudy Regional Market Analysis database, the Bureau of Primary Healthcare (BPHC) Physicians Uniform Data System, the Current Population Survey, Census of Governments, and the Census Bureau’s Annual Survey of State and Local Government Finances. A major innovation of this research is the calculation of detailed measures of safety net availability: We calculate the distance between each uninsured individual and the nearest BPHC provider, public hospital and emergency room. We analyze outpatient care utilization (office-based physician and non-physician visits, emergency department visits) and medical expenditures. We simulate utilization for a number of health care market and safety net values using standardized predictions.
Population Studied: Uninsured adults in the U.S.
Findings: Distances between the rural uninsured and safety net providers such as hospital emergency rooms, public hospitals, migrant health centers, public housing primary care programs, and community health centers are significantly associated with utilization of a variety of healthcare services. In urban areas, we find that the percentage of individuals in the area who are uninsured and the pervasiveness and competitiveness of managed care have a significant relationship with healthcare utilization.
Conclusions: Absent the universal provision of health insurance, policy approaches to alleviating the barriers to access facing the uninsured include incremental efforts to increase the affordability and availability of public or private health insurance as well as measures to increase the accessibility of healthcare for the remaining uninsured. Our findings shed light on areas of focus for the latter class of measures. Facilitating transport to safety net providers and increasing the number of such providers are likely to improve access to care among the rural uninsured. ur findings for urban areas suggest that particular attention be paid to the uninsured living in areas where many of those insured are covered by managed care, and especially so where little competition among managed care organizations exists. Ironically, the “backlash” against managed care may result in improved access to care for some uninsured, although the salutary effects would be offset to the extent that the backlash also results in increasing healthcare costs, greater numbers of uninsured, and more competition for healthcare resources.
