title: Spillover effects of community uninsurance on working-age adults and seniors: an instrumental variables analysis.
abstract: BACKGROUND
  : Previous research suggests, but does not definitively establish, that a high level of uninsurance in a community may negatively affect access to and quality of health care for insured persons.
  
  
  OBJECTIVE
  : To assess the effect of the level of uninsurance in a community on access to and satisfaction with care-an important dimension of quality-among insured persons.
  
  
  METHODS
  : The 1996 to 2006 Medical Expenditure Panel Survey Household Component data linked to data from the Current Population Survey, Area Resource File, and the InterStudy Competitive Edge. Analyses include 86,928 insured adult respondents living in approximately 200 large metropolitan areas.
  
  
  METHODS
  : Measures of whether an individual had a usual source of care, had any delay/difficulty obtaining needed care, used office-based services, used prescription drug services, and used any medical services, and measures of satisfaction with care.
  
  
  RESULTS
  : Among privately insured adults, a higher community uninsurance rate resulted in a lower probability of having a usual source of care, having an office-based visit, having any medical expenditures, and reporting being satisfied with the quality of care provided by the usual source of care. A higher community uninsurance rate also led to a higher probability of reporting difficulty obtaining needed care. Among Medicare enrollees, a higher community uninsurance rate resulted in lower reported satisfaction with care and higher probability of experiencing difficulty or delay in getting needed care.
  
  
  CONCLUSIONS
  : Our results suggest substantial spillover effects of the community uninsurance rate on access to and satisfaction with health care among insured working-age adults and seniors. Consequently, new efforts to address the problem of the uninsured may bring significant benefits to persons who already have insurance.
authors.affiliation: RAND Corporation, 1200 S. Hayes St. Arlington, VA 22202-5050, USA. gresenz@rand.org
authors.forename: Carole Roan
authors.initials: CR
authors.lastname: Gresenz
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003153:Community Health Services; D005260:Female; D006264:Health Benefit Plans, Employee; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D016013:Likelihood Functions; D008297:Male; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014481:United States