The presence of a large uninsured population may create incentives to providers that affect the care delivered to all individuals in a health care market. Using Current Population Survey data on uninsurance rates and hospital discharge data on Medicare beneficiaries, this study investigates the relationship between the uninsurance rate at the metropolitan statistical area (MSA) level and inpatient quality of care delivered to Medicare beneficiaries, as measured by mortality from eight procedures and conditions. The results do not indicate large or widespread negative effects of the uninsured on Medicare beneficiaries. However, some evidence suggests that the relationship between the local uninsurance rate and Medicare mortality does vary by market size.
References
1.
Agency for Healthcare Research and Quality. 2007. Guide to Inpatient Quality Indicators: Quality of Care in Hospitals — Volume, Mortality and Utilization. Version. 3.1 (March 12, 2007)). Rockville, Md.: Agency for Healthcare Research and Quality.
2.
BakerL. C.1997. The Effect of HMOs on Fee-for-Service Health Care Expenditures: Evidence from Medicare. Journal of Health Economics16: 453–481.
3.
BakerL. C.1999. Association of Managed Care Market Share and Health Expenditures for Fee-for-Service Medicare Patients. Journal of the American Medical Association281 (5): 432–437.
4.
BundorfM. K.SchulmanK. A.StaffordJ. A.GaskinD.JollisJ. G.EscarceJ. J.2004. Impact of Managed Care on the Treatment, Costs, and Outcomes of Fee-for-Service Medicare Patients with Acute Myocardial Infarction. Health Services Research39 (1): 131–152.
5.
ChernewM.1995. The Impact of Non-IPA HMOS on the Number of Hospitals and Hospital Capacity. Inquiry32 (2): 143–154.
6.
Congressional Budget Office (CBO). 2010. Cost Estimate for H.R. 4872, Reconciliation Act of 2010 (Final health care legislation). March 20. Washington, D.C.: CBO.
7.
CunninghamP. J.GinsburgP. B.2001. What Accounts for Differences in Uninsurance Rates Across Communities?Inquiry38 (1): 6–21.
8.
DranoveD.SimonC. J.WhiteW. D.1998. Determinants of Managed Care Penetration. Journal of Health Economics17: 729–745.
9.
ElixhauserA.SteinerC.HarrisD. R.CoffeyR. M.1998. Comorbidity Measures for Use with Administrative Data. Medical Care36 (1): 8–27.
10.
FinkelsteinA.2007. The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare. Quarterly Journal of Economics122 (1): 1–37.
11.
GaskinD.SpencerC. S.RichardP.AndersonG. F.PoweN. R.LaVeistT. A.2008. Do Hospitals Provide Lower Quality Care to Minorities than Whites?Health Affairs27 (2): 518–527.
12.
GlazerJ.McGuireT.2002. Multiple Payers, Commonality and Free-Riding in Health Care: Medicare and Private Payers. Journal of Health Economics21 (6): 1049–1069.
13.
GliedS.ZivinJ. Graff. 2002. How Do Doctors Behave When Some (But Not All) of Their Patients are in Managed Care?Journal of Health Economics21 (2): 337–353.
14.
GresenzC. R.EscarceJ. J.2011. Spillover Effects of Community Uninsurance on Working-age Adults and Seniors: An Instrumental Variables Analysis. Medical Care49 (9): e14–e21.
15.
HadleyJ.2003. Sicker and Poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work and Income. Medical Care Research and Review60 (2): 3S–75S.
16.
HorwitzJ.NicholsA.2007. What Do Nonprofits Maximize? Nonprofit Hospital Service Provision and Market Ownership Mix. NBER Working Paper 13246. Cambridge, Mass.: National Bureau of Economic Research (NBER).
17.
Institute of Medicine (IOM). 2003. A Shared Destiny: Community Effects of Uninsurance. Washington D.C.: National Academies Press.
18.
Institute of Medicine (IOM). 2009. America's Uninsured Crisis: Consequences for Health and Health Care. Washington D.C.: National Academies Press.
19.
JhaA. K.OravJ.ZhongheL.EpsteinA. M.2007. Concentration and Quality of Hospitals That Care for Elderly Black Patients. Archives of Internal Medicine167 (11): 1177–1182.
20.
KenneyG.LynchV.ZuckermanS.PhongS.2009. Variation in Insurance Coverage Across Congressional Districts: New Estimates from 2008. October. Washington, D.C.: Urban Institute.
21.
KesslerD.GeppertJ.2005. The Effects of Competition on Variation in the Quality and Cost of Medical Care. Journal of Economics and Management Strategy14 (3): 575–589.
22.
McClellanM. B.StaigerD.1999. The Quality of Health Care Providers. NBER Working Paper No. 7327. Cambridge, Mass.: National Bureau of Economic Research (NBER).
23.
McMorrowS.2010. Local Uninsurance Rates and Hospital Service Provision. American Society of Health Economists Biennial Conference, Ithaca, N.Y., June 2010.
24.
MutterR. L.WongH. S.GoldfarbM. G.2008. The Effects of Hospital Competition on Inpatient Quality of Care. Inquiry45 (3): 263–279.
25.
PaganJ. A.PaulyM. V.2006. Community-Level Uninsurance and the Unmet Medical Needs of Insured and Uninsured Adults. Health Services Research41 (3): 788–803.
26.
PaulyM. V.PaganJ. A.2007. Spillovers and Vulnerability: The Case of Community Uninsurance. Health Affairs26 (5): 1304–1314.
27.
SabikL. M.2012. The Effect of Community Uninsurance Rates on Access to Health Care. Health Services Research47 (3): 897–918.
28.
ShenY. C.2003. The Effect of Financial Pressure on the Quality of Care in Hospitals. Journal of Health Economics22: 243–269.
