Berk, ML, Schur, CL, & Cantor, JC. (1995). Ability to obtain health care: recent estimates from the Robert Wood Johnson Foundation National Access to Care Survey. Health Affairs 14(3): 139-146.
In Berk et al. (1995), the researchers investigate Americans' ability to access health care. The findings hypothesize that a more concrete definition of health care needs, including supplementary services like dental and mental health care, among others, is needed to find ways to improve access to needed services. The data set examined in this study included findings from the 1994 National Access of Care Survey, which included 75% of the noninstitutionalized US population. Telephone and in-person interviews had been conducted in order to receive data on health care and related access to it.
The researchers found that nearly 16.1 percent of Americans could not obtain one or more services that were perceived as needed, including supplementary services. Male and female adults were found to be more likely than children to express unmet needs in their health care, due to Medicaid eligibility and local programs for children. 24% of blacks had unmet needs, on average, and 18% of Hispanics also expressed this opinion - much less than the 15% of whites who mentioned unmet needs. Health insurance (or lack thereof) was determined to be the most important reason for unmet needs - uninsured people had a 250% higher likelihood of having unmet services. The researchers conclude that income and insurance status has a very strong correlation with unmet needs in terms of receiving proper health care. However, the majority of people who reported problems accessing this care were not poor.
Ku, L & Matani, S. (2001) Left out: Immigrants' access to health care and insurance. Health Affairs 20(1): 247-256.
In Ku and Matani's (2001) study, the access to insurance and health care received by immigrants is studied. The hypothesis was that recent changes in healthcare and legislative policy have left immigrants with fewer opportunities and lower access to health care and insurance. The 1997 National Survey of America's Families (NSAF) is used as a data set, with a sample size of nearly 110,000 noninstitutionalized people in America. Data recorded in the survey, including employment status, income, nationality, citizen status and access to health insurance was examined.
According to the findings, more than half of the adults and children in the sample who were classified as 'low-income' had no insurance. Furthermore, the likelihood of having insurance dropped dramatically for non-citizens than native-born citizens, particularly coming from Medicaid or job-based insurance. The children of immigrants had much lower access to health care than native-born children of native families, as well, despite children's ostensible access to Medicaid. It was perceived that other barriers (socioeconomic and communicative in nature) prevented their access to health care. In conclusion, policy changes must be made in order to include these impoverished and underrepresented groups, to guarantee or increase the chance of them receiving emergency room and ambulatory medical care.
McWilliams, JM, Meara, E, Zaslavsky, AM, & Ayanlan, JZ. (2007). Use of health services by previously uninsured Medicare benificiaries. New England Journal of Medicine 257: 145-153.
McWilliams et al. (2007), in their study, examined the extent of use of health services by people who entered Medicare at 65 without having any prior insurance up to that date. the researchers hypothesized that they would have greater rates of morbidity and would cost more to care for than those who had insurance previously. The researchers used longitudinal data from the Health and Retirement Study, updated through 2004, which included a national sample of 9760 participants (an 82% response rate), to examine the health care costs and medical care associated with Medicare recipients who had not been insured before. Propensity-score methods were used to compare the expenditures and health care use between those who were previously uninsured and those who were previously insured for various characteristics, including diabetes and cardiovascular disease.
According to the findings, the nearly 3000 adults among the study whose Medicare coverage was the first insurance they had received experienced much higher incidences of doctor's visits and hospital stays. Furthermore, higher total medical expenditures were found in freshly insured adults than those who were previously insured. In conclusion, the researchers advocate for expanding health insurance coverage for existing adults to offset higher health care use and spending for those same adults after they reach the age of 65 and start on Medicare.
Weinick, RM, Weigers, ME & Cohen, JW. (1998). Children's health insurance, access to care, and health status: new findings. Health Affairs 17(2): 127-136.
In this study by Weinick et al. (1998), the success of recent efforts to improve the health of children in America is evaluated. This is done through examining the success rates in improving access to health care, children's health insurance coverage, and the health status of children. Their hypothesis was that race/ethnicity, the education of parents, and employment status play significant factors in the health status of children and the risk of encountering problems within the American health care system.
The researchers collected data from the 1996 Medical Expenditure Panel Survey (MEPS), a comprehensive American health care survey. This is a longitudinal study that collected data from approximately 74% of American households. This study examined factors including health insurance coverage, health status of children, and others. According to the findings, race and ethnicity played significant roles in restricting access to health care. Hispanic children had the lowest likelihood of having insurance among all ethnicity, and had the poorest general health. Other factors that correlated to individuals lacking health insurance for their children included having only twelve years or fewer of education, parents who were unemployed, or had only one employed parent. Children under the age of six were more likely to be insured than teenagers 13 to 17.
The researchers conclude that there are many barriers to receiving child health insurance, leaving many children without reasonable or frequent access to health care. This leads to poor health, and must be addressed. The primary barriers include race and ethnicity, lack of education and employment status. New health-related programs must be targeted to these vulnerable groups to make the biggest difference in childrens' health.
Zuvekas, SH & Taliaferro, GS. (2009). Pathways to Access: Health Insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999. Health Affairs 22(2): 139-153.
In Zuvekas & Taliaferro (2009), a study was conducted examining pathways to access in health insurance, and how that relates to racial and ethnic disparities. The researchers hypothesize that racial and ethnic disparities exist alongside disparities in access to health care, due to their restricted ability to receive needed health care services. The data used in the study comes from the 1996, 1998 and 1999 Medical Expenditure Panel Surveys and the local area variables coming from the RAF (Area Resource File) to supplement previous data. These statistics are then used to examine factors pertaining to access to the health care system, including potential variables.
According to their findings, blacks and Hispanics had a much smaller chance of using non-ER ambulatory treatments, and visits were fewer overall. Better health is discounted as the reason for fewer visits, as whites reported better health overall. For children, the disparity is even greater, as minority children in particular avoided medical care, to the tune of 55% and 60% of black and Hispanic children as opposed to the 76% of while children who had an ambulatory visit. Blacks were also more reticent to report the need for treatment than whites, which may contribute to fewer visits. Pathways to health insurance coverage, including creating public insurance solutions for those without private insurance, are explored as well. The researchers conclude that disparities exist between ethnicities due to access to health insurance, limited health care delivery systems, and appropriate income and education among affected parties.
Summary:
Barriers to health insurance being established, many policy changes and suggestions were made as to determine methods of increasing access to health care. The benefits of increased access to health insurance include lower rates of morbidity and decreased costs overall (for both insurance companies, the health care system and the individual) when compared to being uninsured. CHIP-funded state plans, in which more public health insurance options are made available, would allow for some of these barriers to health insurance to be addressed; with income and race being sidestepped as a means to gain health insurance, more people would be able to access the care they need. Expansion of Medicaid services, including clinics and hospitals, and providing more comprehensive translator availability could allow immigrants and other non-English speakers to have increased access to health insurance.
Another potential solution to increasing access to health care is to improve overall socioeconomic conditions to lessen the burden that race and income have as a barrier to accessing health insurance. When systemic trends of race and lower-income increasingly prevent ethnic minorities to access health care, allowing opportunities for lower-income families to have job-based health insurance or afford private health insurance is also a viable, if ambitious option.
References
Berk, ML, Schur, CL, & Cantor, JC. (1995). Ability to obtain health care: recent estimates from
the Robert Wood Johnson Foundation National Access to Care Survey. Health Affairs
14(3): 139-146.
Ku, L & Matani, S. (2001) Left out: Immigrants' access to health care and insurance. Health
Affairs 20(1): 247-256.
McWilliams, JM, Meara, E, Zaslavsky, AM, & Ayanlan, JZ. (2007). Use of health services by
previously uninsured Medicare benificiaries. New England Journal of Medicine 257:
145-153.
Weinick, RM, Weigers, ME & Cohen, JW. (1998). Children's health insurance, access to care,
and health status: new findings. Health Affairs 17(2): 127-136.
Zuvekas, SH & Taliaferro, GS. (2009). Pathways to Access: Health Insurance, the health care
delivery system, and racial/ethnic disparities, 1996-1999. Health Affairs 22(2): 139-153.
