NCPA - National Center for Policy Analysis


March 22, 2006

The structure and funding of public "safety net" medical services -- like community and migrant worker health centers and public hospitals -- plays a key role in determining whether uninsured children receive health care, says RAND Corporation.

According to a recent study of more than 2,600 children ages 2 to 17 who were uninsured for at least one full calendar year from 1996 to 2000, urban children were found to be more likely to receive medical care if they live in areas where safety net providers are better funded and where there are more primary care physicians, says RAND.


  • Nearly 60 percent of the children had no physician visits during the preceding year, and slightly less than half received no health care services of any kind.
  • Patterns of care did not differ significantly between uninsured children from rural and urban areas.

However, whether uninsured children receive medical care is not exclusively determined by personal and familial characteristics, but rather by the areas where the children live, says RAND:

  • In urban areas, children who lived in regions where local governments spent more on health and hospitals were more likely to receive medical care.
  • Greater funding in urban areas may allow for additional staffing at safety net providers, the introduction of more convenient hours of operation, or more steeply discounted prices for care.
  • A greater number of primary care physicians also increased the chance of care for uninsured children in urban areas, possibly because a larger supply of physicians made it easier to find a doctor willing to provide free or discounted care, researchers said.

Despite efforts to expand government programs that provide health insurance to children, recent estimates suggest that 12 to 13 percent of the nation's children remain without health coverage, says RAND.

Source: Editorial, "Rand Study Finds Medical Safety Net Plays Key Role In Providing Care To Uninsured Children," RAND Corporation, March 6, 2006; based upon: Carole Roan Gresenz et al, "Dimensions of the Local Health Care Environment and Use of Care by Uninsured Children in Rural and Urban Areas," Journal of the American Academy of Pediatrics, March 3, 2006.

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