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OCR for page 105
A
A Conceptual Framework for
Evaluating the Consequences
of Uninsurance:
A Cascade of Effects
The Committee's general conceptual framework for evaluating the conse-
quences of uninsurance is depicted in Figure A.1. This overall conceptualization
was the basis of the Committee's model for this report on health outcomes, as
depicted in Figure 1.1. Both versions of the conceptual framework are based upon
a widely employed behavioral model of access to health services that explicates the
processes of health care and health-related outcomes for individuals (Andersen
and Davidson, 2001~.
Figure A.1 groups variables into the categories of resources that promote or
enable one to obtain health care; personal or community characteristics that favor or
predispose action to obtain health care; and needs for health care, as articulated by
those in need, determined by health care providers, or identified by researchers
and decision makers. Judgments about how susceptible a variable is to change are
implicit in the categories of resources, characteristics, and needs. Resources are
considered, at least theoretically, as more open to change. Characteristics are less
manipulable and needs comprise a heterogeneous grouping, with some needs
more changeable than others.
The overall model begins with the primarily economic determinants of health
insurance status in Panel 1 of the figure. Panel 2 displays, in compressed form, the
resources, characteristics, and needs of both individuals and communities that
affect the process of obtaining access to health care. Panel 3 displays the conse-
quences of uninsurance that are being examined in the Committee's various
reports. These effects cascade from the smallest unit of analysis, the individual, to
increasingly larger units, first that of the family and then the community. Panel 2
and one element of Panel 3, "Health Outcomes for Individuals," represent the
105
OCR for page 106
06
CARE WITHOUT COVERAGE: TOO LITTLE, TOO LATE
focus of Care Without Coverage. These sections of the overall framework are
expanded upon in Figure 1.1.
The arrows and arrangement of the boxes in Figure A. 1 indicate hypothesized
causal and temporal relationships. As reflected by the figure, the relationships
among factors that determine health insurance status, access to health care, and
health, social, and economic outcomes are dynamic with multiple feedbacks. For
example, as discussed earlier in this report, health status is both an outcome
variable in this model and an important determinant of health insurance status, the
individual and family-level resource that is the independent variable of interest in
this report.
OCR for page 107
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OCR for page 108
Representative terms from entire chapter:
insurance status
