Health Care Markets, the Safety Net and Access to Care Among the Uninsured

Published in: National Bureau of Economic Research, NBER Working Paper 10779, Sep. 2004, 37 Pages

Posted on RAND.org on December 31, 2003

by Carole Roan Gresenz, Jeannette Rogowski, Jose J. Escarce

The authors use nationally representative Medical Expenditure Panel Survey (MEPS) data linked with data from multiple secondary sources to study the relationship between access to care among the uninsured and the local healthcare market and safety net. They find that 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, they find that the capacity of the safety net and the pervasiveness and competitiveness of managed care have a significant relationship with healthcare utilization. Their findings suggest that facilitating transport to safety net providers and increasing the number of such providers are likely to improve access to care among the rural uninsured. By contrast, policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring access among the urban uninsured.

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