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.
Individual‐level data from the 1996 and 2003 ommunity racking tudy, and market‐level data from other sources, including the rea esource ile and the ureau of rimary ealthcare.
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.
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.
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.