vately insured adults’ reported access to and satisfaction with health care. The researchers found that higher community-level uninsurance rates were associated with small but significant declines in the measures of the privately insured adult population’s access to care—including a 4.0-percentage-point decline (from 92.0 to 88.0 percent) in the probability of having a place to go when sick and a 2.2-percentage-point decline (from 64.8 to 62.6 percent) in the probability of having a routine preventive care visit. In addition, Pauly and Pagán found that higher community-level uninsurance rates were associated with small but significant declines in the measures of the privately insured adult population’s satisfaction with care—including a 7.1-percentage-point decline (from 62.7 to 55.6 percent) in satisfaction with one’s choice of primary care physician and a 2.7-percentage-point decrease (from 74.5 to 71.8 percent) in satisfaction with one’s choice of specialist.

Other Research on Spillover Effects of High Community-Level Rates of Uninsurance

Other research is consistent with the findings of the 2008 Pauly and Pagán analysis commissioned by the committee. In 2006, Pagán and Pauly used the 2000-2001 Community Tracking Household Survey to assess the impact of community uninsurance on the medical needs of working-age, privately and publicly insured adults. They found that in communities with higher uninsurance rates, insured adults were more likely to report having an unmet medical need in the previous year (Pagán and Pauly, 2006). Insured adults in such communities were also more likely to report being in only fair to poor health.

In 2007, Pagán and colleagues used the 2000-2001 Community Tracking Physician Survey and the 2000-2001 and the 2003 Community Tracking Household Survey to assess the relationship between community uninsurance and primary care physicians’ career satisfaction, perceptions about quality of care, and patients’ trust in their physicians (Pagán et al., 2007).5 The analysis included data from 4,920 primary care (i.e., specialists in internal medicine or general family practice) physician respondents who spent at least 20 hours per week in direct patient care.

5

The 2000-2001 Community Tracking Physician Survey asked physicians about the extent to which they agree with the following statements: (1) I have the freedom to make clinical decisions that meet my patients’ needs; (2) It is possible to provide high quality care to all of my patients; (3) I can make clinical decisions in the best interest of my patients without the possibility of reducing my income; (4) The level of communication I have with specialists about the patients I refer to them is sufficient to ensure the delivery of high-quality care; and (5) It is possible to maintain the kind of continuing relationships with patients over time that promote the delivery of high-quality care. The researchers developed dichotomous variables to capture whether a respondent agreed strongly or somewhat with each of the statements.



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