Changes in access to care, 1977-1996: The role of health insurance

Objective. To describe changes in Americans' access to care over the last 2 0 years focusing on the uninsured, Hispanic American, and young adult popul ations, and to analyze the factors underlying these changes with a particul ar focus on the role of health insurance. Data Sources/Study Setting. Data from the 1977 National Medical Care Expend iture Survey, the 1987 National Medical Expenditure Survey, and the 1996 Me dical Expenditure Panel Survey. Study Design. Focusing on whether each individual has a usual source of hea lth care, we present descriptive statistics and algebraic decompositions. Data Collection/Extraction Methods. We combine data from the household surv eys with questions from access to care supplements that were administered e ach time. Principal Findings. Hispanic Americans and young adults age 18-24 are more likely to lack a usual source of care than other Americans; these inequalit ies increased over the period studied and cannot be explained solely by cha nges in health insurance coverage. Conclusions. Although increasing health insurance coverage will likely impr ove access to care among Hispanics and young adults, our findings suggest t hat the expansion of insurance coverage will not be sufficient to eliminate current disparities in access to care.