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Pressures on the Health Care Safety Net:
Implications for Access to Care for the Uninsured
o examine the effects of managed care penetration and the rate of uninsurance on low income peoples access to health care, as well as differences in access between low income people with and without health insurance, the author used the Community Tracking Study household survey as a source of data. Measures of managed care included both overall and Medicaid managed care penetration in the community. There were three measures of access to care: a usual source of care, any ambulatory care use and unmet medical needs. The study also controlled for other individual and community characteristics associated with access. The results showed that low income uninsured people had less access to care in states with high Medicaid managed care penetration. Differences in access to care between those with and those without health insurance is greater in areas with high Medicaid managed care penetration. The author concluded that efforts to lower health care costs may result in financial pressures that limit subsidization of care to the medically indigent, especially for providers who depend heavily on Medicaid revenue. Cunningham also found that higher uninsurance rates in a community are associated with lower access for the uninsured.
Free access to this article is available at the Health Services Research Web site.