Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

We use nationally representative Medical Expenditure Panel Survey (MEPS) data linked with data from multiple secondary sources to study the relationship between access to care among the uninsured and the local healthcare market and safety net. We find that distances between the rural uninsured and safety net providers such as hospital emergency rooms, public hospitals, migrant health centers, public housing primary care programs, and community health centers are significantly associated with utilization of a variety of healthcare services. In urban areas, we find that the capacity of the safety net and the pervasiveness and competitiveness of managed care have a significant relationship with healthcare utilization. Our findings suggest that facilitating transport to safety net providers and increasing the number of such providers are likely to improve access to care among the rural uninsured. By contrast, policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring access among the urban uninsured.

Functional Associations of “Trouble Seeing”

The purpose of this study was to determine how vision problems affect health status. The information was collected in 1990 from 2,249 household heads and spouses over 50 years of age during an annual survey of a nationally representative sample that was adjusted for attrition and nonresponse. Vision problems were defined as “trouble seeing (even with glasses or contact lenses).” Health status was measured principally with the Medical Outcomes Study Short-Form 36. Regression analyses found a significant relationship between “trouble seeing” and each of five health-status domains. We conclude that it may not be appropriate to require specific functional limitations as a precondition for cataract surgery and that instruments for measuring functional disabilities related to vision should include more general questions

Patient Cost-Sharing and Hospitalization Offsets in the Elderly

In the Medicare program, increases in cost sharing by a supplemental insurer can exert financial externalities. We study a policy change that raised patient cost sharing for the supplemental insurer for retired public employees in California. We find that physician visits and prescription drug usage have elasticities that are similar to those of the RAND Health Insurance Experiment (HIE). Unlike the HIE, however, we find substantial "offset" effects in terms of increased hospital utilization. The savings from increased cost sharing accrue mostly to the supplemental insurer, while the costs of increased hospitalization accrue mostly to Medicare.Kaiser Family FoundationNational Institute on Aging (NIA P01 AG19783-02)National Bureau of Economic Research (Aging Fellowship