Would safety-net expansions offset reduced access resulting from lost insurance coverage? Race/ethnicity differences

Health Affairs

Volumn 25, Issue 6, 2006, Pages 1679-1687

  Hadley, Jack ^a,b   Cunningham, Peter ^c   Hargraves, J Lee ^d  

^a CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^b URBAN INSTITUTE   (United States)

^c HSC ^*

^d UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AFRICAN AMERICAN; ARTICLE; CAUCASIAN; CLASSIFICATION; COMPARATIVE STUDY; COMPUTER SIMULATION; ECONOMICS; EPIDEMIOLOGY; ETHNOLOGY; HEALTH CARE DELIVERY; HEALTH CENTER; HISPANIC; HUMAN; MINORITY GROUP; PATIENT; POVERTY; PRIMARY HEALTH CARE; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

AFRICAN AMERICANS; COMMUNITY HEALTH CENTERS; COMPUTER SIMULATION; EUROPEAN CONTINENTAL ANCESTRY GROUP; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HISPANIC AMERICANS; HUMANS; MEDICALLY UNINSURED; MINORITY GROUPS; POVERTY; PRIMARY HEALTH CARE; UNITED STATES;

EID: 33845326802     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.6.1679     Document Type: Article

References (27)

1. C. DeNavas-Walt, B. Proctor, and C. Lee, Income, Poverty, and Health Insurance Coverage in the United States: 2004, U.S. Census Bureau, Current Population Reports P60-229 (Washington: U.S. Government Printing Office, 2005).
2. Tabulated from U.S. Census Bureau, Historical Health Insurance Tables, http://www.census.gov/hhes/www/hlthins/historic/index.html (accessed 23 June 2006).
3. Agency for Healthcare Research and Quality, 2005 National Healthcare Disparities Report, Pub. no. 06-0017 (Rockville, Md.: AHRQ, 2005).
4. A.S. O'Malley et al., "Health Center Trends, 1994-2001: What Do They Portend for the Federal Growth Initiative?" Health Affairs 24, no. 2 (2005): 465-472.
5. White House, "State of the Union: Affordable and Accessible Health Care," Press Release, 31 January 2006, http://www.whitehouse.gov/news/ releases/2006/01/20060131-7.html (accessed 23 June 2006).
6. M. Proser, The Role of Health Centers in Reducing Health Disparities, Special Topics Issue Brief no. 2 (Bethesda, Md.: National Association of Community Health Centers, July 2003).
7. M. Lillie-Blanton and C. Hoffman, "The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care," Health Affairs 24, no. 2 (2005): 398-408.
8. J.L. Hargraves and J. Hadley, "The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care," Health Services Research 38, no. 3 (2003): 809-829;
9. and S.H. Zuvekas and G.S. Taliaferro, "Pathways to Access: Health Insurance, the Health Care Delivery System, and Racial/Ethnic Disparities, 1996-1999," Health Affairs 22, no. 2 (2003): 139-153.
10. B. Spillman, S. Zuckerman, and B. Garrett, "Does the Health Care Safety Net Narrow the Access Gap?" Discussion Paper no. 03-02 (Washington: Urban Institute, April 2003).
11. J. Hadley and P. Cunningham, "Availability of Safety Net Providers and Access to Care of Uninsured Persons," Health Services Research 39, no. 5 (2004): 1527-1546.
12. For a concise introduction to endogeneity bias and themethod of instrumental variable analysis, see M.B. McClellan and J.P. Newhouse, "Overview of the Special Supplement Issue," Health Services Research 35, no. 5, Part 2 (2000): 1061-1069.
13. P. Cunningham and J. Hadley, "Expanding Care versus Expanding Coverage: How to Improve Access to Care," Health Affairs 23, no. 4 (2004): 234-244.
14. The survey instrument was translated into Spanish. Bilingual interviewers administered the Spanish version if the respondent preferred to conduct the interview in Spanish.
15. R. Strouse, B. Carlson, and J. Hal, Community Tracking Study: Household Survey Methodology Report 2000-01 (Round Three), Technical Pub. no. 46 (Washington: Center for Studying Health System Change, 2003).
16. Asians and other racial/ethnic minorities are omitted from the analysis because there are too few cases for reliable statistical estimation.
17. J. Reschovsky, J. Hadley, and L. Nichols, "Why Are So Many Latinos Uninsured in the United States?" (Working Paper, HSC, 2006);
18. and T. Waidmann, B. Garrett, and J. Hadley, "Explaining Differences in Employer Sponsored Insurance Coverage by Race, Ethnicity, and Immigrant Status" (Working Paper, Urban Institute, 2004).
19. M. Proser, P. Shin, and D. Hawkins, A Nation's Health at Risk III: Growing Uninsured, Budget Cutbacks Challenge President's Initiative to Put a Health Center in Every Poor County, Special Topics Issue Brief no. 9 (Bethesda Md.: NACHC, 2005).
20. Whether a five-mile radius for providers is considered "nearby" is likely to differ across communities. Although using different radii based on community characteristics would have been difficult, controlling for whether the site was a large metropolitan site (greater than 200,000 population), small metro site, or nonmetro site did not materially affect the results for the effects of safety-net providers. For prior research, see D. Dranove, W. White, and L. Wu, "Segmentation in Local Hospital Markets," Medical Care 31, no. 1 (1993): 52-64;
21. and M.A. McGuirk and F.W. Porell, "Spatial Patterns of Hospital Utilization: The Impact of Distance and Time," Inquiry 21, no. 1 (1984): 84-95.
22. A description of the Uniform Data System is available on the Bureau of Primary Health Care Web site, http://www.bphc.hrsa.gov/uds (accessed 23 August 2006).
23. This approach is equivalent to estimating separate models for each racial and ethnic subpopulation but has the advantage of avoiding small-sample problems that can occur with separate models because of the relatively small numbers of English- and Spanish-speaking Hispanics.
24. Methodological details and complete statistical models are reported in a separate online statistical appendix. See http://content.healthaffairs.org/cgi/ content/full/25/6/1679/DC1.
25. Ibid.
26. U.S. Government Accountability Office, Community Health Centers: Adapting to Changing Health Care Environment Key to Continued Success, Pub. no. GAO/HEHS-00-39 (Washington: GAO, 2000);
27. and A. Markus, D. Roby, and S. Rosenbaum, A Profile of Federally Funded Health Centers Serving a Higher Proportion of Uninsured Patients (Washington: Henry J. Kaiser Family Foundation, June 2002).