Address correspondence to José A. Pagán, Ph.D., Professor, Department of Economics and Finance, College of Business Administration, The University of Texas-Pan American, 1201 W. University Dr., Edinburg, TX 78541. Dr. Pagán is also Director of the Institute for Population Health Policy at The University of Texas-Pan American and Senior Fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA. Mark V. Pauly, Ph.D., Bendheim Professor, is with the Health Care Systems Department, Wharton School, Philadelphia, PA and is Senior Fellow of the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
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Community-Level Uninsurance and the Unmet Medical Needs of Insured and Uninsured Adults
Article first published online: 25 JAN 2006
DOI: 10.1111/j.1475-6773.2006.00506.x
Additional Information
How to Cite
Pagán, J. A. and Pauly, M. V. (2006), Community-Level Uninsurance and the Unmet Medical Needs of Insured and Uninsured Adults. Health Services Research, 41: 788–803. doi: 10.1111/j.1475-6773.2006.00506.x
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Address correspondence to José A. Pagán, Ph.D., Professor, Department of Economics and Finance, College of Business Administration, The University of Texas-Pan American, 1201 W. University Dr., Edinburg, TX 78541. Dr. Pagán is also Director of the Institute for Population Health Policy at The University of Texas-Pan American and Senior Fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA. Mark V. Pauly, Ph.D., Bendheim Professor, is with the Health Care Systems Department, Wharton School, Philadelphia, PA and is Senior Fellow of the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Publication History
- Issue published online: 25 JAN 2006
- Article first published online: 25 JAN 2006
- Abstract
- Article
- References
- Cited By
Keywords:
- Uninsured;
- communities;
- access;
- spillovers
Objective. To examine the relationship between community-level uninsurance rates and the self-reported unmet medical needs of insured and uninsured adults in the U.S.
Data Sources. 2000–2001 Community Tracking Study, which includes data from 60 randomly selected U.S. communities. The sample is representative of the contiguous U.S. states.
Study Design. Multilevel logistic regressions were employed to investigate whether the local uninsurance rate was related to having reported unmet medical needs within the last year. The models also included individual and community variables that could be potentially related to both community uninsurance rates and having reported unmet medical needs.
Principal Findings. The community uninsurance rate was positively associated with having reported unmet medical needs, but only for insured adults. On average, a five percentage point increment in the local uninsured population is associated with a 10.5 percent increase in the likelihood that an insured adult will report having unmet medical needs during the 12-month period studied.
Conclusion. Local health care delivery systems seem to be negatively affected by high uninsurance rates. These effects could have negative consequences for health care access, even for individuals who are themselves insured.