Expanding Care Versus Expanding Coverage: How to Improve Access to Care

The Two Strategies Should be Viewed as Complements, not Competitors

July/August 2004
Health Affairs , Vol. 23, No. 4
Peter J. Cunningham, Jack Hadley

The Bush administration has proposed expanding insurance coverage as well as community health centers (CHCs) to increase access to care for uninsured people. This paper examines the relative effects of insurance coverage and CHC capacity on access to care. Communities that have both high insurance coverage and extensive CHC capacity tend to have the best access, although the former appears more important. Funding of insurance coverage expansions is likely to produce greater gains in access than if an equivalent level of funding were invested in CHCs. Policymakers should consider CHC expansions as complementary to insurance coverage expansions rather than as a substitute.