Consider local health care systems when designing services for the uninsured
Research Activities, August 2010, No. 360
Policymakers continue to be challenged to improve access to health care services by the uninsured. Individuals without insurance may be better or worse off depending on the community in which they live, concludes a new study. It found, for example, that Hispanic mothers living in a Minnesota community with a large insured population benefitted from the higher quality care demanded by those who were insured. In contrast, Hispanic mothers living in a Texas community with a nearly 25 percent uninsurance rate suffered poorer quality of care and often crossed the border into Mexico to get prescription drugs and treatment.
These findings suggest that policies created for the uninsured need to take into account the individual characteristics of the local health care system. For example, policies in the Minnesota community might consider interventions to improve care access such as translators and interpreters that are not typically offered due to low demand. In the Texas community, policies might focus on reducing the number of individuals without coverage, which could have a substantial impact on the spillover-induced care quality, suggest the researchers.
Their study focused on uninsured Hispanic mothers residing in two communities located in Minnesota and Texas. At the time of the study, Minnesota had the lowest overall rate of residents without insurance; only 18 percent of its residents were uninsured. In Texas, however, nearly a quarter of residents were uninsured and 60 percent of the population was Hispanic. All of the 17 mothers from each community cared for at least one child. Focus groups conducted by the researchers asked the participants about where they went for health care, how they paid for it, and their perceptions about quality. Demographic information was also collected.
The uninsured mothers residing in Minnesota gave higher marks for the quality of care services than their Texas counterparts. However, the Minnesota mothers also pointed to the high costs of such care in their State and the high price of insurance premiums. They also reported difficulty obtaining care from safety-net clinics or hospitals, as well as language barriers and long wait times. Texas mothers described the health care they received from clinics, hospitals, and providers as poor overall. The mothers also admitted to crossing the border to Mexico to receive care and obtain medications. The study was supported in part by the Agency for Healthcare Research and Quality (HS17003).
See "Context matters: Where would you be the least worse off in the U.S. if you were uninsured?" by Carolyn Garcia, Ph.D., M.P.H., R.N., José A. Pagán, Ph.D., and Rachel Hardeman, M.P.H., in Health Policy 94, pp. 76-83, 2010.