: 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.
[Show abstract][Hide abstract] ABSTRACT: The presence of a large uninsured population may create incentives to providers that affect the care delivered to all individuals in a health care market. Using Current Population Survey data on uninsurance rates and hospital discharge data on Medicare beneficiaries, this study investigates the relationship between the uninsurance rate at the metropolitan statistical area (MSA) level and inpatient quality of care delivered to Medicare beneficiaries, as measured by mortality from eight procedures and conditions. The results do not indicate large or widespread negative effects of the uninsured on Medicare beneficiaries. However, some evidence suggests that the relationship between the local uninsurance rate and Medicare mortality does vary by market size.
Inquiry: a journal of medical care organization, provision and financing 05/2013; 50(1):57-70. DOI:10.2307/23480897 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: It is widely recognized that there is significant state-level variation in scope-of-practice regulations (SSoPRs) for nurse practitioners (NPs). PURPOSE: This study was designed to examine whether SSoPRs influence labor markets for NPs. METHOD: Cross-sectional analysis examining how SSoPRs influence the number and growth in NPs; data from the Area Resource File and 2008 Pearson report were used. DISCUSSION: Restrictive SSoPRs reduced the number of NPs by about 10 per 100,000 and reduced the growth rate by 25%. No difference was found between states with the most restriction and those with some restrictions. CONCLUSIONS: These results imply that changes to practice regulations should not be incremental but should follow the current practices in the least restrictive states. Results also indicate that other factors (poverty, uninsurance rates, rurality) decreased the number of NPs, suggesting that solving the primary care provider shortage will require multiple strategies.
Nursing outlook 05/2013; 61(6). DOI:10.1016/j.outlook.2013.04.007 · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Patient Protection and Affordable Care Act will expand Medicaid coverage substantially, with the goal of improving the health of low-income individuals and reducing disparities in coverage and access. Whether insurance expansions are successful in achieving this goal will depend in part on physician response to changes in insurance coverage mix and the effect of this response on access to care for low-income safety net populations.
The objective of the study was to consider the impact of changes in market-level Medicaid coverage on measures of physician participation in care for safety net populations.
We use 4 waves of the Community Tracking Study Physician Survey from 1996 to 2005. We estimate both market-level and physician-level fixed effects models, to consider changes in market-level Medicaid rates on measures of physician acceptance of new patients (both Medicaid patients and uninsured patients unable to pay), revenue from Medicaid, and provision of charity care. We also stratify the sample to investigate whether effects differ among office-based versus facility-based physicians.
Increases in Medicaid coverage are associated with statistically significant decreases in the likelihood that physicians will accept new uninsured patients who are unable to pay, particularly among office-based physicians. Increases in Medicaid coverage are not associated with changes in acceptance of new Medicaid patients.
Past changes in Medicaid coverage rates are not associated with changes in physician acceptance of new Medicaid patients or provision of charity care, although they are associated with lower acceptance of new uninsured patients, particularly among office-based physicians.
Medical care 11/2013; 51(11):978-984. DOI:10.1097/MLR.0b013e3182a50305 · 3.23 Impact Factor
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