Where Would You Rather Live If You Were Insured? Assessing Community Uninsurance Spillover Effects on the Insured

Springer Science and Business Media LLC - Tập 14 - Trang 706-714 - 2011
Rachel R. Hardeman1, Carolyn García2, José A. Pagán3,4
1School of Public Health, University of Minnesota, Minneapolis, USA
2School of Public Health and School of Nursing, University of Minnesota, Minneapolis, USA
3Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, USA
4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA

Tóm tắt

This study sought to understand the cost, quality of, and access to health care for the insured population in the context of spillover effects resulting from community-level uninsurance. We examined the health care access, quality, and cost experienced by insured Latina mothers in two communities, Minneapolis, Minnesota and McAllen, Texas. These communities differ substantially by the size of the local population without health insurance coverage. Four focus groups were conducted with insured Latina mothers who were caring for at least one child in their household. Eleven and thirteen mothers participated in each community, respectively. The experiences of the insured population in McAllen were substantially different from the experiences of the insured population in Minneapolis. The perceptions of health care quality and access by insured Latina mothers were substantially lower in McAllen while out-of-pocket costs were perceived to be higher in Minneapolis. Our study provides key insights about the US health care system and the role that the relative size of the local uninsured population may have in impacting the health care experiences of the insured. Health insurance coverage rates are expected to increase substantially across US communities within the next few years but local health care system challenges related to cost, quality, and access will remain for both the insured and the uninsured.

Tài liệu tham khảo

Davis K. A new era in American health care: realizing the potential of reform. New York: The Commonwealth Fund; 2010. The Congressional Budget Office. Cost estimate of H.R. 4872, Reconciliation Act of 2010. Retrieved from http://www.cbo.gov/doc.cfm?index=11379; June 2010. Institute of Medicine: Committee on the Consequences of Uninsurance. Care without coverage: too little, too late. Washington: National Academies Press; 2002. Gilmer T, Kronick R. It’s the premiums, stupid: projections of the uninsured through 2013. Health Aff. 2005; Jan–Jun Suppl Web Exclusives:W5-143–W5-151. Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. J Am Med Assoc. 2000;284:2061–9. Baker DW, Sudano JJ, Albert JM, Borawski EA, Dor A. Lack of health insurance and decline in overall health in late middle age. N Engl J Med. 2001;345:1106–12. Dor A, Sudano J, Baker DW. The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study. Health Serv Res. 2006;41:759–87. Institute of Medicine: Committee on the Consequences of Uninsurance. A shared destiny: community effects of uninsurance. Washington, DC: National Academies Press; 2003. Bastida E, Brown HS, Pagán JA. Persistent disparities in the use of health care along the US-Mexico border: an ecological perspective. Am J Public Health. 2008;98:1987–95. Pauly MV, Pagán JA. Spillovers and vulnerability: the case of community uninsurance. Health Aff. 2007;26:1304–14. Pauly MV, Pagán JA. Spillovers of uninsurance in communities, Institute of Medicine Commissioned Paper. Retrieved from http://www.iom.edu/~/media/Files/Activity%20Files/HealthServices/UninsuredConsequence/Commissioned%20Paper%20-%20Pauly%20and%20Pagan%202008%20%20Spillovers%20of%20Uninsurance%20in%20Communities.ashx. Pagán JA, Pauly MV. Community-level uninsurance and the unmet medical needs of insured and uninsured adults. Health Serv Res. 2006;41:788–803. Institute of Medicine: Committee on the Consequences of Uninsurance. Coverage matters: insurance and health care. Washington, DC: National Academies Press; 2001. Morgan D. The focus group guidebook. Thousand Oaks: SAGE Publications; 1998. The Henry J. Kaiser Family Foundation. Statehealthfacts.org, 2008. Available from: http://statehealthfacts.org; 2008. Gawande A. The cost conundrum. New Yorker. 2009, June 1, pp. 36–44. US Census Bureau. State & county Quickfacts: Hennepin County, MN, November 4, 2010. Retrieved 18 Mar 2011, from http://quickfacts.census.gov. US Census Bureau, 2005–2009 American community survey. ACS demographic and housing estimates: 2005–2009, Hennepin County, MN. Retrieved 18 Mar 2011, from http://factfinder.census.gov. Minnesota Department of Health. System hospitals. Retrieved 18 Mar 2011 from http://www.health.state.mn.us/traumasystem/designatedhospitals.html. US Census Bureau. State & county Quickfacts: Hildago County, TX. November 4, 2010. Retrieved 18 Mar 2011, from http://quickfacts.census.gov. US Census Bureau. 2005–2009 American community survey. ACS demographic and housing estimates: 2005–2009, Hidalgo County, TX. Retrieved 18 Mar 2011, from http://factfinder.census.gov. Texas Department of Health. Texas trauma facilities, March 17, 2011. Retrieved 18 Mar 2011 from http://www.dshs.state.tx.us/emstraumasystems/etrahosp.shtm#level I. Area Resource File (ARF). US department of health and human services, health resources and services administration, bureau of health professions, Rockville, MD; 2009–2010. Urban Institute and Kaiser Commission on Medicaid and the Uninsured Estimates Based on the Census Bureau’s March 2009 and 2010 Current Population Survey (CPS: Annual social and economic supplements). Retrieved 21 Mar 2011, from http://www.statehealthfacts.org; 2009. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ. Lucas0 FL, Pinder EL. The implications of regional variations in medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288–98. Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff (Millwood). 2004;Suppl Web:W4-184-97.