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Availability of Safety Net Providers and Access to Care of Uninsured Persons


  • Jack Hadley,

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    • Address correspondence to Jack Hadley, Ph.D., and Senior Fellow, Center for Studying Health System Change, 600 Maryland Ave., SW, Suite 550, Washington DC 20024. Dr. Hadley is also Principal Research Associate, The Urban Institute, Washington, DC. Peter Cunningham, Ph.D., is a Senior Health Researcher, Center for Studying Health System Change.

  • Peter Cunningham

  • The Center for Studying Health System Change is supported in full by the Robert Wood Johnson Foundation.


Objective. To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons.

Data Sources. The 1998–1999 Community Tracking Study household survey, administered primarily by telephone survey to households in 60 randomly selected communities, linked to data on community health centers, other free clinics, and safety net hospitals.

Study Design. Instrumental variable estimation of multivariate regression models of several measures of access to care (having a usual source of care, unmet or delayed medical care needs, ambulatory service use, and overnight hospital stays) against endogenous measures of distances to the nearest community health center and safety net hospital, controlling for characteristics of uninsured persons and other area characteristics that are related to access to care. The models are estimated with data from a nationally representative sample of uninsured people.

Principal Findings. Shorter distances to the nearest safety net providers increase access to care for uninsured persons. Failure to account for the endogeneity of distance to safety net providers on access to care generally leads to finding little or no safety net effects on access.

Conclusions. Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions.