Availability of Safety Net Providers and Access to Care of Uninsured Persons

Abstract

Objective. To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons. Data Sources. The 1998–1999 Community Tracking Study household survey, administered primarily by telephone survey to households in 60 randomly selected communities, linked to data on community health centers, other free clinics, and safety net hospitals. Study Design. Instrumental variable estimation of multivariate regression models of several measures of access to care (having a usual source of care, unmet or delayed medical care needs, ambulatory service use, and overnight hospital stays) against endogenous measures of distances to the nearest community health center and safety net hospital, controlling for characteristics of uninsured persons and other area characteristics that are related to access to care. The models are estimated with data from a nationally representative sample of uninsured people. Principal Findings. Shorter distances to the nearest safety net providers increase access to care for uninsured persons. Failure to account for the endogeneity of distance to safety net providers on access to care generally leads to finding little or no safety net effects on access. Conclusions. Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions.

Would Safety-Net Expansions Offset Reduced Access Resulting From Lost Insurance Coverage? Race/Ethnicity Differences

“…10 Using an appropriate statistical method, they found that greater proximity to safety-net providers has a statistically significant and positive effect on several measures of access to care. 11 In a study of the effects of insurance coverage and safety-net capacity on having a usual source of care, Cunningham and Hadley used an improved measure of safety-net availability (total grant revenues received by federally qualified CHCs within a five-mile radius of survey respondents) and treated both insurance coverage and safety-net capacity as endogenous.…”

Eliminating Disparities in Cardiovascular Health

“…In particular, it will be necessary to support and enhance safety net programs. [42][43][44][45][46] Geography, Local Environment, and Socioeconomic Influences Disparities in cardiovascular health on the basis of geographic location of residence and local environment are well documented. [47][48][49][50] For example, rural residents have important healthcare challenges in addition to access barriers.…”

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

“…Other instruments such as voting patterns in the county, generosity of the state AFDC benefit, and the number of medical school faculty in the county failed empirical tests for appropriateness. These measures offered better identifying power in other research (Hadley and Cunningham 2004b) when used to instrument for the location of safety net providers. But, these are also likely to be correlated with access to care, and are also county and state level instruments, which cannot capture within-county or within-state variation in the instrumented variable.…”