September 9, 1998
Journal of the American Medical Association , vol.280, no.10 (September 9, 1998): 921-927
Peter J. Cunningham, Peter Kemper
ecause communities differ in the way medical care for the indigent is organized and delivered, there are likely to be differences in the ability of the uninsured to obtain medical care. The authors analyzed the 1996-1997 Community Tracking Study Household Survey, which included a random sample of 60 communities nationwide. The survey represented 60,446 individuals in these communities, of whom 7,200 were uninsured. Results of the analysis showed a twofold difference across communities in the ability of the uninsured to obtain medical care, indicating that place of residence is an important determinant in access to care. Most of the difference in access remained even when controlling for health status and other individual characteristics. Despite these differences, additional analysis showed that expanding insurance would do more to improve access for the uninsured across all communities, compared to expanding the direct delivery of services. Place of residence is likely to remain an important factor because provision of medical care for the uninsured is driven largely by state and local policy.
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