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Long SH, Marquis MS. Geographic Variation in Physician Visits for Uninsured Children: The Role of the Safety Net. JAMA. 1999;281(21):2035–2040. doi:10.1001/jama.281.21.2035
Author Affiliations: The authors are Senior Economists, RAND, Washington, DC.
Context Although an extensive literature exists comparing
national access to health care for uninsured vs insured children, few
data exist regarding differences in access across states.
Objective To examine variation in access to physician
services for uninsured children in 10 states, the safety net's role in
explaining this variation, and the potential effects of the State
Children's Health Insurance Program (CHIP) on insurance coverage and
Design and Setting The population-based Robert Wood Johnson
Foundation Family Health Insurance Survey, conducted between summer
1993 and spring 1994 in 10 states (Colorado, Florida, Minnesota, New
Mexico, New York, North Dakota, Oklahoma, Oregon, Vermont, and
Washington), with a response rate of families by state ranging from
61% to 83%.
Participants A total of 8565 children who were uninsured (1586),
covered by Medicaid (2723), or covered by employer-sponsored private
insurance (4256) for 1 full year prior to the survey.
Main Outcome Measures Percentage of low-income children who are
uninsured and predicted annual physician visits by state if insurance
was provided to uninsured children in families with incomes of less
than 200% of poverty level.
Results In the 10 study states, low-income children ranged from
61% to 86% of all uninsured children and the uninsured rate for
low-income children varied from 9% to 31%. On average, providing
public coverage would increase annual physician visits from 2.3 to 4.6
(a 105% increase), but the increase would range from 41% to 189%
across states. The annual physician visit rate in the 3 states with the
highest access for the uninsured was 160% of that in the 3
lowest-access states. Safety net capacity in the high-access states
ranged from 120% to 220% of that in the low-access states.
Conclusions Our data suggest that the potential effects of CHIP
vary substantially across states. Notably, improvements in access to
health care by uninsured low-income children should be greater in
states with the fewest safety net resources.
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