title: Understanding and measuring health care insecurity.
abstract: OBJECTIVE
  To define the concept of "health care insecurity,” validate a new self-report measure, and examine the impact of beginning care at a free clinic on uninsured patients' health care insecurity.
  
  
  METHODS
  Consecutive new patients presenting at a free clinic completed 15 items assessing domains of health care insecurity (HCI) at their first visit and again four to eight weeks later. Psychometrics and change of the HCI measure were examined.
  
  
  RESULTS
  The HCI measure was found to have high internal consistency (α=0.94). Evidence of concurrent validity was indicated by negative correlation with VR-12 health-related quality of life physical and mental health components and positive correlation with the Perceived Stress Scale. Predictive validity was shown among the 83% of participants completing follow-up: HCI decreased after beginning care at a free clinic (p<.001).
  
  
  CONCLUSIONS
  Reliably assessing patient experience of health care insecurity is feasible and has potential to inform efforts to improve quality and access to care among underserved populations.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Tomsik
authors.forename: Samantha
authors.initials: S
authors.lastname: Smith
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Mason
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Zyzanski
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.forename: James J
authors.initials: JJ
authors.lastname: Werner
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D011594:Psychometrics; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires