December 2006

Grant Results

National Program

Changes in Health Care Financing and Organization

SUMMARY

In this 1999–2001 project, Barry G. Saver, M.D., M.P.H., and researchers at the University of Washington, examined whether community-level characteristics, such as unequal income distribution and segregation in housing, affect the decision to purchase private health insurance.

Researchers estimated the probability of individuals purchasing individual insurance, delaying or not obtaining care, utilizing outpatient services and having a regular source of care. A Findings Brief on the project is available at the HCFO Web site.

This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO) (for more information see Grant Results).

Key Findings
Among the findings in the brief, are the following. See Findings for a complete list.

  • African-American and Hispanic individuals were less likely to purchase individual health insurance than non-Hispanic whites.
  • There was little evidence that individuals in areas with a strong local safety net were less likely to purchase individual health insurance.
  • Minority individuals were not only less likely to have a regular source of medical care than non-minorities, but were also seen less often by the same provider even if they had a regular source of care.
  • Community characteristics that decreased the chances that people would have a usual source of care or annual physician visits included increased managed care penetration, higher cost of living and greater proportions of uninsured residents.

Funding
RWJF provided a $100,729 grant to the project from March 1999 to February 2001.

 See Grant Detail & Contact Information
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THE PROJECT

Low-income racial and ethnic minorities are disproportionately represented among those without health insurance. Researchers at the University of Washington in Seattle examined the effect of community level factors (such as the presence and strength of local safety nets, housing segregation and income inequality) versus individual factors (such as age, income and education) on racial and ethnic disparities in the purchase of non-group health insurance and in health care access.

The primary data source was RWJF's 1996–1997 Community Tracking Study Household Survey, a telephone survey of over 60,000 individuals from 60 communities. Additional data sources included the US Bureau of the Census, the federal Area Resource File (a database of health care system data for each county in the United States) and community and migrant health centers' Medicare cost reports.

The populations of interest were African-American and Hispanic adults under age 65 without employer- or public-sponsored health insurance.

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FINDINGS

Researchers reported the following findings in a Findings Brief available on the HCFO Web site:

  • African-American and Hispanic individuals were less likely to purchase individual health insurance than non-Hispanic whites. In comparison to other minority groups, non-English speaking Hispanics were even less likely to purchase individual health policies. More educated and higher-income minority individuals were more likely to purchase such insurance than less educated and lower-income minority individuals. However, even better educated minority individuals were substantially less likely to purchase individual insurance than were non-Hispanic whites with similar levels of education.
  • There was little evidence that individuals in areas with a strong local safety net were less likely to purchase individual health insurance. Researchers assumed strong safety nets in those areas with a high number of visits to community health centers and public and teaching hospital outpatient departments; high per capita numbers of physicians and hours of physician charity care; and state and federal primary care funding. A strong local safety net did not appear to substitute for purchase of individual insurance.
  • Minority individuals were not only less likely to have a regular source of medical care than non-minorities, but were also seen less often by the same provider even if they had a regular source of care. This is a result of minority health care occurring more often in hospital outpatient departments or community health centers, rather than in physician offices. Minority individuals were also less trusting of their physicians and less satisfied with their interactions with their physicians.
  • Community characteristics that decreased the chances that people would have a usual source of care or annual physician visits included increased managed care penetration, higher cost of living and greater proportions of uninsured residents. In contrast, having a usual source of care was positively associated with a higher number of physicians per capita in the community and greater teaching hospital capacity.
  • Community-level factors did not significantly affect racial and ethnic disparities in health care access.
  • Preventive care is more likely to occur with continuity of care through a single health care provider. In comparison to other groups, young, uninsured African-American males who were healthy, light smokers and who used few health services were less likely to report receiving advice to quit smoking.

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GRANT DETAILS & CONTACT INFORMATION

Project

Research on the Effects of Social Inequality on Racial and Ethnic Minority Groups and the Role of the Safety Net - Health Tracking Joint Solicitation

Grantee

University of Washington (Seattle,  WA)

  • Amount: $ 100,729
    Dates: March 1999 to February 2001
    ID#:  036332

Contact

Barry G. Saver, M.D., M.P.H.
(206) 543-2461
Saver@u.washington.edu

Web Site

http://www.hcfo.net

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Doescher MP and Saver BG. "Physicians' Advice to Quit Smoking: The Glass Remains Half-Empty." Journal of Family Practice, 49(6): 543–547, 2000. Abstract available online.

Doescher MP, Saver BG, Fiscella K and Franks P. "Preventive Care: Does Continuity Count?" Journal of General Internal Medicine, 19(6): 632–637, 2004. Abstract available online.

Doescher MP, Saver BG, Fiscella K and Franks P. "Racial/Ethnic Inequities in Continuity and Site of Care: Location, Location, Location." Health Services Research, 36(6, Part 2): 78–89, 2000. Abstract available online.

Doescher MP, Saver BG, Franks P and Fiscella K. "Racial and Ethnic Disparities in Perceptions of Physician Style and Trust." Archives of Family Medicine, 9(10): 1156–1163, 2000. Abstract available online.

Saver BG, Doescher MP, Symons JM, Wright GE and Andrilla CH. "Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family-Level Factors." Health Services Research, 38(1 Pt. 1): 211–231, 2003. Abstract available online.

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Report prepared by: Mary Geisz
Reviewed by: Robert Crum
Reviewed by: Molly McKaughan
Program Officer: Nancy L. Barrand

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