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The Effect of Community Uninsurance Rates on Access to Health Care
Author(s) -
Sabik Lindsay M.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01364.x
Subject(s) - spillover effect , instrumental variable , health care , health insurance , demographic economics , medicine , actuarial science , econometrics , business , economics , microeconomics , economic growth
Objective To investigate the effect of local uninsurance rates on access to health care for the uninsured and insured and improve on recent studies by controlling for time‐invariant differences across markets. Data Sources Individual‐level data from the 1996 and 2003 C ommunity T racking S tudy, and market‐level data from other sources, including the A rea R esource F ile and the B ureau of P rimary H ealthcare. Study Design Market‐level fixed effects models estimate the effect of changes in uninsurance rates within markets on access to care, measured by whether individuals report forgoing necessary care. Instrumental variables models are also estimated. Principal Findings Increases in the rate of uninsurance are associated with poorer access to necessary care among the uninsured. In contrast with recent evidence, increases in uninsurance had no effect on access to care among the insured. Instrumental variables results are similar, although not statistically significant. Conclusions Changes in rates of insurance coverage are likely to affect access to care for both previously and continuously uninsured. In contrast with earlier studies, there is no evidence of spillover effects on the insured, suggesting that such policy changes may have little effect on access for those who are already insured.