Center for Studying Health System Change

Health Care Safety Net Awareness Low Among Uninsured People

Few Uninsured View Hospitals as Safety Net Despite Reliance on Emergency Departments

News Release
Nov. 17, 2004

FURTHER INFORMATION, CONTACT:
Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—More than half of all uninsured Americans are unaware of a community safety net provider where they can receive lower-cost, affordable health care, according to a national study released today by the Center for Studying Health System Change (HSC).

Many of the poorest and most disadvantaged uninsured people apparently do not use or are unaware of the health care safety net, including 4.6 million uninsured poor people, 5.7 million uninsured Latinos and 2.4 million uninsured African Americans. Moreover, a striking number of uninsured people—about 7.9 million—are unaware of a safety net provider despite living within 5 miles of a community health center (CHC).

"The findings indicate that many uninsured people are unaware of an affordable source of care to turn to when they need medical attention, putting them at higher risk of going without medical attention," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Researchers asked uninsured people about their use and awareness of medical care providers that offer lower-cost and affordable care. Uninsured people with a usual source of medical care were asked, "At this place, do you pay full price for medical care or do you pay a lower amount based on what you can afford to pay?" In addition, uninsured people who did not pay a lower price at their usual source of medical care or who did not have a usual source of care were asked, "Thinking of the area where you live, is there a place that offers affordable medical care for people without insurance?"

Taken together, responses to the two questions indicate that less than half of the uninsured (48%)—or about 18 million people—use or are aware of a safety net provider in their community, according to HSC’s Community Tracking Study 2003 Household Survey, a nationally representative survey involving information on 46,600 people.

"Even if uninsured people don’t have an immediate need for care, awareness of a place to receive affordable care could encourage them to seek timely care if the need arises, instead of waiting until their condition becomes more severe," said HSC Senior Health Researcher Peter J. Cunningham, Ph.D., who co-authored the study with HSC Health Research Assistant Jessica H. May and HSC Senior Fellow Jack Hadley, Ph.D.

Poor and lower-income uninsured people—those with incomes below 200 percent of the federal poverty level, or $36,800 for a family of four in 2003—were more likely to know of a safety net provider in their community than uninsured people with higher incomes. For example, 54 percent of uninsured people with incomes below poverty were aware of a safety net provider compared with 43 percent of uninsured people with incomes at or above 300 percent of poverty.

Awareness of a local safety net provider also was higher among uninsured racial and ethnic minorities, likely in part because they tend to have lower average incomes than uninsured whites. More than half of uninsured blacks (57%) and Latinos (53%) knew of a safety net provider in their community, compared with about four in 10 uninsured whites (41%).

Physician offices and clinics/health centers were identified as the most common sources of lower-cost care. Of uninsured people who were aware of safety net providers, 45 percent cited a clinic or health center as a safety net provider, while about one-fourth (26%) identified a physician office.

Hospital outpatient clinics and emergency departments were much less likely to be identified as safety net providers, although other HSC research has shown that the uninsured receive more than half of their outpatient care from hospital-based facilities. Only 8 percent of uninsured people who were aware of safety net providers in their community identified a hospital emergency department as a safety net provider.

"While uninsured people may be frequent emergency department users because of a lack of alternatives—and because by law they can’t be turned away—these findings suggest that they don’t necessarily regard ERs as places to receive affordable or lower-cost care," Cunningham said.

The study’s findings are detailed in a new HSC Issue Brief—Most Uninsured People Unaware of Health Care Safety Net Providers. Other key findings include:

• Uninsured people living within 5 miles of a community health center (CHC) are more likely to be aware of a safety net provider compared with uninsured people who do not live near a CHC (53% vs. 43%).
• Almost two-thirds (64%) of uninsured people identify a single place where they usually go to receive medical care. However, less than half (45%) of uninsured people with a usual source of care reported paying less than full price for care. The uninsured are more likely to have a safety net provider as their usual source of medical care if they are poor (55%), black (56%), Latino (61%) and live closer to CHCs (54%). Additionally, uninsured people in poorer health also are more likely to have a safety net provider as a usual source of care.
• Awareness of the safety net other than through a usual source of medical care appears to be much more limited. For uninsured people without a safety net provider as a usual source of care, less than one-third (29%) were aware of safety net providers in their community

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.