title: Where would you rather live if you were insured? Assessing community uninsurance spillover effects on the insured.
abstract: This study sought to understand the cost, quality of, and access to health care for the insured population in the context of spillover effects resulting from community-level uninsurance. We examined the health care access, quality, and cost experienced by insured Latina mothers in two communities, Minneapolis, Minnesota and McAllen, Texas. These communities differ substantially by the size of the local population without health insurance coverage. Four focus groups were conducted with insured Latina mothers who were caring for at least one child in their household. Eleven and thirteen mothers participated in each community, respectively. The experiences of the insured population in McAllen were substantially different from the experiences of the insured population in Minneapolis. The perceptions of health care quality and access by insured Latina mothers were substantially lower in McAllen while out-of-pocket costs were perceived to be higher in Minneapolis. Our study provides key insights about the US health care system and the role that the relative size of the local uninsured population may have in impacting the health care experiences of the insured. Health insurance coverage rates are expected to increase substantially across US communities within the next few years but local health care system challenges related to cost, quality, and access will remain for both the insured and the uninsured.
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA. hard0222@umn.edu
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Hardeman
authors.forename: Carolyn
authors.initials: C
authors.lastname: García
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
mesh_terms: D000328:Adult; D003258:Consumer Behavior; D005260:Female; D017144:Focus Groups; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000208:ethnology / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008910:Minnesota; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013781:Texas; D014481:United States