title: The effect of community uninsurance rates on access to health care.
abstract: OBJECTIVE
  To investigate the effect of local uninsurance rates on access to health care for the uninsured and insured and improve on recent studies by controlling for time-invariant differences across markets.
  
  
  METHODS
  Individual-level data from the 1996 and 2003 Community Tracking Study, and market-level data from other sources, including the Area Resource File and the Bureau of Primary Healthcare.
  
  
  METHODS
  Market-level fixed effects models estimate the effect of changes in uninsurance rates within markets on access to care, measured by whether individuals report forgoing necessary care. Instrumental variables models are also estimated.
  
  
  RESULTS
  Increases in the rate of uninsurance are associated with poorer access to necessary care among the uninsured. In contrast with recent evidence, increases in uninsurance had no effect on access to care among the insured. Instrumental variables results are similar, although not statistically significant.
  
  
  CONCLUSIONS
  Changes in rates of insurance coverage are likely to affect access to care for both previously and continuously uninsured. In contrast with earlier studies, there is no evidence of spillover effects on the insured, suggesting that such policy changes may have little effect on access for those who are already insured.
authors.affiliation: Department of Healthcare Policy and Research, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Sabik
mesh_terms: D000328:Adult; D005260:Female; D019981:Health Care Sector; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D014481:United States