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Factors Other than Health Insurance Coverage Responsible for Declines in Access for Young Adults and All Hispanics

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Press Release Date: April 6, 1999

Declines in health insurance coverage were responsible for only one-fifth of the declines in access to health care services experienced by Hispanic Americans and young adults aged 18-24 between 1977 and 1996, according to a new study by researchers at the Agency for Health Care Policy and Research. The authors, Samuel H. Zuvekas, Ph.D. and Robin M. Weinick, Ph.D., conclude that simply increasing health insurance coverage will not be enough to eliminate these disparities. The study was published in a special supplement of Health Services Research.

The authors analyzed data from three nationally representative medical expenditure surveys conducted by AHCPR in 1977, 1987, and 1996. They looked at three groups (Hispanic Americans, young adults aged 18-24, and the uninsured) and their access to care, measured by whether they had a usual source of health care. In conducting this study, the authors specifically isolated the role of health insurance, which is widely believed to be the primary determinant of access to care, from other factors.

"This research shows that there are factors other than health insurance which affect access to care," said John M. Eisenberg, M.D., AHCPR administrator. "We are learning more from research like this about how insurance coverage is the first step toward access to high quality services, but not the last step. Policymakers are paying attention to the research that shows how many factors need to be addressed—and barriers broken down—to improve the availability of health care services for all Americans."

Hispanic Americans were affected both by declining rates of insurance and, for those who were uninsured, declining rates of access to care, as measured by usual source of care. The proportion of Hispanic Americans with a usual source of health care declined from 80.3 percent in 1977 to 70.4 percent in 1996. During this same period, in addition to declining rates of insurance and declining rates of access among the uninsured, young adults with insurance experienced declines in access. The percentage of young adults with a usual source of care declined from 78.6 percent to 66 percent. Overall, during this period, the percentage of all uninsured Americans with a usual source of care declined from 74.4 percent to 62 percent.

These declines resulted in growing gaps in access to care between these groups and other Americans over the last 20 years. The authors found that even if rates of health insurance had remained constant, these groups still would have experienced declines in access to care.

Details are in "Changes in Access to Care, 1977-1996: The Role of Health Insurance," published in a special supplement, HSR: Health Services Research 34:1 (April 1999, Part II), p. 271-279.

For additional information contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (; Karen Migdail, (301) 427-1855 (

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