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Peter J. Cunningham


Managed Care and Physicians' Provision of Charity Care

March 24-31, 1999
Journal of the American Medical Association

Ability to Obtain Medical Care for the Uninsured

September 9, 1998
Journal of the American Medical Association

A Changing Picture of Uncompensated Care

July/August 1997
Health Affairs

Staying in the Game:

March 1999
Research Report No. 03

Do HMOs Make a Difference?

Winter 1999/2000

Pressures on the Health Care Safety Net:

Implications for Access to Care for the Uninsured

April 1999
Health Services Research, vol.34, no.1 (April 1999): 255-270
Peter J. Cunningham

o examine the effects of managed care penetration and the rate of uninsurance on low income people’s 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.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.