Working Paper: NBER ID: w10799
Authors: Carole Roan Gresenz; Jeannette A. Rogowski; Jos J. Escarce
Abstract: We 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. We 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, we find that the capacity of the safety net and the pervasiveness and competitiveness of managed care have a significant relationship with healthcare utilization. Our 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.
Keywords: healthcare access; uninsured; safety net; managed care; healthcare market
JEL Codes: I1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| longer distances from rural uninsured individuals to safety net providers (R29) | lower healthcare utilization (I19) |
| increased capacity of safety net providers (I18) | increased healthcare utilization among both rural and urban uninsured populations (I13) |
| greater HMO penetration in urban areas (I11) | decreased physician visits (I11) |
| greater HMO penetration in urban areas (I11) | increased reliance on non-physician providers (I11) |
| competition among managed care organizations (L13) | more favorable outcomes for uninsured individuals in competitive markets (I11) |