Health care markets, the safety net, and utilization of care among the uninsured

Health Services Research, Feb, 2007 by Carole Roan Gresenz, Jeannette Rogowski, Jose J. Escarce

Our findings shed light on areas of focus for the latter class of measures. Specifically, facilitating transport to safety-net providers and increasing the number of such providers are likely to increase utilization of care among the rural uninsured. Our sensitivity analyses suggest that these policies may matter most for the poorest of the rural uninsured. By contrast, the HMO 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 (Robinson 2004), although the salutary effects would be offset to the extent that the backlash also results in increasing health care costs, greater numbers of uninsured, and more competition for health care resources. In addition, policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring the urban uninsured are able to obtain care. Researchers have reported a relatively stable trend in safety net capacity in the late 1990s to 2001 (Felland et al. 2003), but the absolute level of capacity has been shown to vary widely across communities (Marquis et al. 2004), and some research suggests that those disparities may be widening over time (Hoadley, Felland, and Staiti 2004). Increasing budgetary pressures at the federal level and in many states are likely to pose an increasing threat to safety-net funding.

ACKNOWLEDGMENTS

This study was supported by program project grant P01-HS10770 from the Agency for Healthcare Research and Quality. We are grateful to Sue Polich for her expertise in working with the MEPS household survey data, Randy Hirscher and Jill Gurvey for building the file describing the health care market and safety net structure, Susan Marquis for sharing her measures of safety-net capacity, Beth Eiseman and Jessie Riposo for assistance with on-site work at AHRQ, and to AHRQ for their willingness to clean and add individuals' zipcode to the MEPS restricted use files, with a special thanks to Bill Carroll who facilitated the process and Ray Kuntz who provided assistance at the AHRQ Data Center.

Disclosures: None

Disclaimers: None

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