Geographic Variation in Physician Visits for Uninsured Children

The Role of the Safety Net

by M. Susan Marquis, Stephen H. Long


Purchase Print Copy

 FormatList Price
Add to Cart Paperback6 pages Free

This study examines variation in access to physician services for uninsured children in 10 states, the safety net's role in explaining this variation, and the potential effects of the State Children's Health Insurance Program (CHIP) on insurance coverage and access. Data were drawn from the population-based Robert Wood Johnson Foundation Family Health Insurance Survey, conducted between summer 1993 and spring 1994 in 10 states. The analysts estimated the percentage of low-income children who are uninsured and predicted annual physician visits in each state if insurance was provided to uninsured children in families with incomes of less than 200% of poverty level. They found that low-income children ranged from 6l% to 86% of all uninsured children and the uninsured rate for low-income children varied from 9% to 31 %. On average, providing public coverage would increase annual physician visits from 2.3 to 4.6 (a 105% increase), but the increase would range from 41 % to 189% across states. The annual physician visit rate in the 3 states with the highest access for the uninsured was 160% of that in the 3 lowest-access states. Safety net capacity in the high-access states ranged from 120% to 220% of that in the low-access states. These data suggest that the potential effects of CHIP vary substantially across states. Notably, improvements in access to health care by uninsured low- income children should be greater in states with the fewest safety net resources.

Originally published in: Journal of the American Medical Association, v. 281, no. 21, June 2, 1999, pp. 2035-2040.

This report is part of the RAND Corporation Reprint series. The Reprint was a product of the RAND Corporation from 1992 to 2011 that represented previously published journal articles, book chapters, and reports with the permission of the publisher. RAND reprints were formally reviewed in accordance with the publisher's editorial policy and compliant with RAND's rigorous quality assurance standards for quality and objectivity. For select current RAND journal articles, see External Publications.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.