The Impact of Insurance Instability on Health Service Utilization: Does Non-metropolitan Residence Make a Difference?

Bronwyn E. Fields, Janice F Bell, Sally Moyce, Jeri L Bigbee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. Methods: A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. Findings: Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. Conclusions: Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalJournal of Rural Health
Volume31
Issue number1
DOIs
StatePublished - Dec 1 2015

Fingerprint

Insurance
Health Services
Health Insurance
Patient Acceptance of Health Care
Office Visits
House Calls
Prescriptions
Hospital Emergency Service
Inpatients
Health
Insurance Coverage
Dental Care
Health Expenditures
Tooth
Emergencies
Cross-Sectional Studies
Odds Ratio
Delivery of Health Care

Keywords

  • Geography
  • Health disparities
  • Health services research
  • Insurance
  • Medical Expenditure Panel Survey

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The Impact of Insurance Instability on Health Service Utilization : Does Non-metropolitan Residence Make a Difference? / Fields, Bronwyn E.; Bell, Janice F; Moyce, Sally; Bigbee, Jeri L.

In: Journal of Rural Health, Vol. 31, No. 1, 01.12.2015, p. 27-34.

Research output: Contribution to journalArticle

@article{6142d3bb453c40e689ace584cca28e3f,
title = "The Impact of Insurance Instability on Health Service Utilization: Does Non-metropolitan Residence Make a Difference?",
abstract = "Purpose: Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. Methods: A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. Findings: Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95{\%} CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95{\%} CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. Conclusions: Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.",
keywords = "Geography, Health disparities, Health services research, Insurance, Medical Expenditure Panel Survey",
author = "Fields, {Bronwyn E.} and Bell, {Janice F} and Sally Moyce and Bigbee, {Jeri L}",
year = "2015",
month = "12",
day = "1",
doi = "10.1111/jrh.12077",
language = "English (US)",
volume = "31",
pages = "27--34",
journal = "Journal of Rural Health",
issn = "0890-765X",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - The Impact of Insurance Instability on Health Service Utilization

T2 - Does Non-metropolitan Residence Make a Difference?

AU - Fields, Bronwyn E.

AU - Bell, Janice F

AU - Moyce, Sally

AU - Bigbee, Jeri L

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Purpose: Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. Methods: A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. Findings: Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. Conclusions: Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.

AB - Purpose: Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. Methods: A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. Findings: Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. Conclusions: Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.

KW - Geography

KW - Health disparities

KW - Health services research

KW - Insurance

KW - Medical Expenditure Panel Survey

UR - http://www.scopus.com/inward/record.url?scp=84920287116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920287116&partnerID=8YFLogxK

U2 - 10.1111/jrh.12077

DO - 10.1111/jrh.12077

M3 - Article

C2 - 25040420

AN - SCOPUS:84920287116

VL - 31

SP - 27

EP - 34

JO - Journal of Rural Health

JF - Journal of Rural Health

SN - 0890-765X

IS - 1

ER -