Health care markets, the safety net, and utilization of care among the uninsured
Health care markets, the safety net, and utilization of care among the uninsured
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DOI：
10.1111/j.1475-6773.2006.00602.x
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发表时间：
2007-02-01
影响因子：
3.4
通讯作者：
Escarce, Jose J.
中科院分区：
文献类型：
--
作者：
Gresenz, Carole Roan;Rogowski, Jeannette;Escarce, Jose J.
目的：量化未参保人群的医疗服务利用与当地医疗服务市场和安全网结构之间的关系。从1996年到2000年的医疗支出调查（MEPS）的全国代表性数据与来自多个二级来源的数据相关联。我们分别分析了门诊服务利用率和个人是否发生任何医疗支出之间的无保险的成年人生活在城市和农村地区。安全网措施包括每个人与最近的安全网提供者之间的距离，以及根据地方政府和医院保健支出衡量的能力。其他协变量包括当地医疗保健市场中的管理式医疗服务，该地区未投保的个人的百分比以及当地初级保健医生的供应。我们模拟使用标准化的预测。主要结果。农村无保险者与安全网提供者之间的距离与利用率显著相关。在城市地区，我们发现，在该地区的个人谁是没有保险的百分比，管理式医疗的普及性和竞争力，初级保健医生的供应，和安全网的能力有显着的关系与卫生保健利用。为安全网提供者提供交通便利并增加此类提供者的数量，可能会增加农村无保险者对护理的利用。我们的研究结果表明，城市地区的无保险生活在管理式医疗存在的地区是大量的，特别是在管理式医疗竞争是有限的，可能是一个目标的政策，以提高无保险的能力，以获得照顾。旨在增加安全网供资和提高安全网提供者能力的政策可能对确保城市无保险者能够获得医疗保健很重要。
Objective, To quantify the relationship between utilization of care among the uninsured and the structure of the local health care market and safety net.Data Sources/Study Setting. Nationally representative data from the 1996 to 2000 waves of the Medical Expenditure Panel Survey (MEPS) linked to data from multiple secondary sources.Study Design. We separately analyze outpatient care utilization and whether an individual incurred any medical expenditure among uninsured adults living in urban and rural areas. Safety net measures include distances between each individual and the nearest safety net providers as well as a measure of capacity based on local government and hospital health expenditures. Other covariates include the managed care presence in the local health care market, the percentage of individuals who are uninsured in the area, and local primary care physician supply. We simulate utilization using standardized predictions.Principal Findings. Distances between the rural uninsured and safety net providers are significantly associated with utilization. In urban areas, we find that the percentage of individuals in the area who are uninsured, the pervasiveness and competitiveness of managed care, the primary care physician supply, and safety net capacity have a significant relationship with health care utilization.Conclusions. Facilitating transport to safety net providers and increasing the number of such providers are likely to increase utilization of care among the rural uninsured. Our findings for urban areas suggest that the uninsured living in areas where managed care presence is substantial, and especially where managed care competition is limited, could be a target for policies to improve the ability of the uninsured to obtain care. Policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring the urban uninsured are able to obtain health care.