Hospital Provision of Uncompensated Care and Public Program Enrollment
Blewett, L. A., G. Davidson, M. Brown, and R. Maude-Griffin. 2003. “Hospital Provision of Uncompensated Care and Public Program Enrollment.” Medical Care Research and Review 60 (4): 509-527.
Hospital provision of uncompensated care is partly a function of insurance coverage of state populations. As states expand insurance coverage options and reduce the number of uninsured, hospital provision of uncompensated care should also decrease. Controlling for hospital characteristics and market factors, the authors estimate that increases in MinnesotaCare (a state-subsidized health insurance program for the working poor) enrollment resulted in a 5-year cumulative savings of $58.6 million in hospital uncompensated care costs. Efforts to evaluate access expansions should take into account the costs of the program and the savings associated with reductions in hospital uncompensated care.
Publication
Missing the Mark? Examining Imputation Bias in the CPS’s State Income and Health Insurance Coverage Estimates
Davern, M., L. A. Blewett, B. Bershadsky, and N. Arnold. 2004. “Missing the Mark? Examining Imputation Bias in the Current Population Survey’s State Income and Health Insurance Coverage Estimates.” Journal of Official Statistics 20(3):519-49.
The Demographic Supplement to the U.S. Current Population Survey (CPS) is used to produce state estimates of health insurance coverage and income. These estimates are used in federal allocation formulas that distribute $10-11 billion annually to states for the State Children's Health Insurance Program (SCHIP) and the Elementary and Secondary Education Act. The purpose of this article is to examine the CPS for evidence of bias in state estimates due to missing data imputation and estimate the extent of the bias for each of the fifty-one states and Washington DC. Comparing three years of CPS (1998-2000), to the Census 2000 Supplementary Survey and 1990 Decennial Census data benchmarks, we find evidence of bias in state estimates of earned income. We also extend the technique to the CPS state health insurance coverage estimates and find even more evidence of bias. In general, the "better off" states (those with higher insurance coverage rates or more income) tend to be even "better off" (have higher estimates of average income and coverage rates) after correcting for bias (and vice versa). We conclude by considering alternative strategies for the U.S. Census Bureau to alter its current imputation procedures.
Publication
Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest
Casey, M., L. A. Blewett, and K. T. Call. 2004. “Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest.” American Journal of Public Health 94(10): 1709-1711.
We examined case studies of 3 rural Midwestern communities to assess local health care systems' response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.
Publication
Covering Kids: Variation in Health Insurance Coverage Trends by State, 1996-2002
Blewett, L. A., M. Davern, and H. Rodin. 2005. “Covering Kids: Variation in Health Insurance Coverage Trends by State, 1996-2002.” Health Affairs 13(6): 170-180.
We estimated state-specific changes in health insurance coverage rates for children between 1996-1998 and 2001-2002. We found considerable variation in the changing distribution of health insurance coverage for children across states, with significant increases in public program coverage in twenty-nine states and significant decreases in uninsured children in twenty-seven. Children in families with incomes below 200 percent of the federal poverty level were the most likely to enroll in public programs. We provide an overview of state outreach and administrative simplification efforts and raise concerns about the persistent variation in children's health insurance coverage across states.
Publication
Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest
Blewett, L. A., M. Casey, and K. T. Call. 2005. “Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest.” Journal of Rural Health Special Issue 20 (3): 237-245.
CONTEXT: Many rural Midwestern communities are experiencing rapid growth in Latino populations with low rates of health insurance coverage, limited financial resources, language and cultural differences, and special health care needs. PURPOSE: We report on 2-day site visits conducted in 2001 and 2002 in 3 communities (Marshalltown, Iowa; Great Bend, Kansas; and Norfolk, Nebraska) to document successful strategies to meet Latino health care needs. METHODS: We interviewed key informants to identify successful community strategies for dealing with health care access challenges facing the growing Latino population in the Midwest. FINDINGS: Interventions have been developed to meet new demands including (1) use of free clinics, (2) school health programs, (3) outreach by public health, social services and religious organizations, and (4) health care providers' efforts to communicate with patients in Spanish. Strain on safety net services for Latinos is due in part to a complicated and unstable mix of public and private funds, a large but overtaxed volunteer provider base, the dependence on a limited number of community leaders, and limited time for coordination and documentation of activities. CONCLUSIONS: We suggest the development of a Rural Safety Net Support System to provide targeted funding to rural areas with growing immigrant populations. Federal community health center support could be redirected to new and existing safety net providers to support the development of a safety net monitoring system.