Article

Spillover Effects of Community Uninsurance on Working-age Adults and Seniors An Instrumental Variables Analysis

RAND Corporation, 1200 S. Hayes St. Arlington, VA 22202-5050, USA.
Medical care (Impact Factor: 2.94). 09/2011; 49(9):e14-21. DOI: 10.1097/MLR.0b013e31822dc7f4
Source: PubMed

ABSTRACT : Previous research suggests, but does not definitively establish, that a high level of uninsurance in a community may negatively affect access to and quality of health care for insured persons.
: To assess the effect of the level of uninsurance in a community on access to and satisfaction with care-an important dimension of quality-among insured persons.
: The 1996 to 2006 Medical Expenditure Panel Survey Household Component data linked to data from the Current Population Survey, Area Resource File, and the InterStudy Competitive Edge. Analyses include 86,928 insured adult respondents living in approximately 200 large metropolitan areas.
: Measures of whether an individual had a usual source of care, had any delay/difficulty obtaining needed care, used office-based services, used prescription drug services, and used any medical services, and measures of satisfaction with care.
: Among privately insured adults, a higher community uninsurance rate resulted in a lower probability of having a usual source of care, having an office-based visit, having any medical expenditures, and reporting being satisfied with the quality of care provided by the usual source of care. A higher community uninsurance rate also led to a higher probability of reporting difficulty obtaining needed care. Among Medicare enrollees, a higher community uninsurance rate resulted in lower reported satisfaction with care and higher probability of experiencing difficulty or delay in getting needed care.
: Our results suggest substantial spillover effects of the community uninsurance rate on access to and satisfaction with health care among insured working-age adults and seniors. Consequently, new efforts to address the problem of the uninsured may bring significant benefits to persons who already have insurance.

0 Followers
 · 
67 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: A lack of health insurance has long been associated with negative effects on individual and family health due to access barriers. However, we know little about how a lack of health insurance affects wider communities beyond health care. Based on in-depth interviews in two Los Angeles communities, we report how a lack of health insurance affects the functioning of religious institutions and schools from kindergarten to 12th grade. We find a negative spillover effect at the individual and institutional levels for schools experiencing greater absenteeism due to health insurance problems of pupils. However, we find that religious organizations are little affected by a lack of health insurance of adherents. Instead, churches offer health programs as a means to engage their communities. Besides documenting a negative and a positive spillover effect, we offer a conceptual framework for the qualitative study of health spillover effects and examine the policy implications of our findings.
    Journal of Health and Social Behavior 09/2014; 55(3):360-74. DOI:10.1177/0022146514543523 · 2.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion). This trend is the projected result of reduced spending on mental health drugs because of patent expirations, the low likelihood of innovative drugs entering the market, and a slowdown in spending growth for hospital treatment. By 2020 the expansion of coverage to previously uninsured Americans under the Affordable Care Act (ACA), combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes.
    Health Affairs 08/2014; 33(8):1407-15. DOI:10.1377/hlthaff.2014.0163 · 4.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although studies have shown that a high rate of uninsurance in a community reduces access to and satisfaction with health care among the insured population, little is known about whether the community uninsurance rate also affects quality of care and clinical outcomes among the insured.
    Medical Care 07/2014; 52(7):626-33. DOI:10.1097/MLR.0000000000000145 · 2.94 Impact Factor