Geographic Variation in Physician Visits for Uninsured Children

The Role of the Safety Net

by M. Susan Marquis, Stephen H. Long

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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.

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