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Health Serv Res. Apr 1999; 34(1 Pt 2): 271–279.
PMCID: PMC1089000

Changes in access to care, 1977-1996: the role of health insurance.


OBJECTIVE: To describe changes in Americans' access to care over the last 20 years focusing on the uninsured, Hispanic American, and young adult populations, and to analyze the factors underlying these changes with a particular focus on the role of health insurance. DATA SOURCES/STUDY SETTING: Data from the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 Medical Expenditure Panel Survey. STUDY DESIGN: Focusing on whether each individual has a usual source of health care, we present descriptive statistics and algebraic decompositions. DATA COLLECTION/EXTRACTION METHODS: We combine data from the household surveys with questions from access to care supplements that were administered each time. PRINCIPAL FINDINGS: Hispanic Americans and young adults age 18-24 are more likely to lack a usual source of care than other Americans; these inequalities increased over the period studied and cannot be explained solely by changes in health insurance coverage. CONCLUSIONS: Although increasing health insurance coverage will likely improve access to care among Hispanics and young adults, our findings suggest that the expansion of insurance coverage will not be sufficient to eliminate current disparities in access to care.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kuder JM, Levitz GS. Visits to the physician: an evaluation of the usual-source effect. Health Serv Res. 1985 Dec;20(5):579–596. [PMC free article] [PubMed]
  • Martin LM, Calle EE, Wingo PA, Heath CW., Jr Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996 Mar-Apr;12(2):82–90. [PubMed]
  • Moy E, Bartman BA, Weir MR. Access to hypertensive care. Effects of income, insurance, and source of care. Arch Intern Med. 1995 Jul 24;155(14):1497–1502. [PubMed]

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