title: Community-level uninsurance and the unmet medical needs of insured and uninsured adults.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Economics and Finance, College of Business Administration, The University of Texas-Pan American, 1201 W. University Dr., Edinburg, TX 78541, USA.
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
authors.forename: Mark V
authors.initials: MV
authors.lastname: Pauly
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D012111:Residence Characteristics; D012650:Self Disclosure; D014481:United States