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

OBJECTIVE: To describe changes in Americans' access to care over the last 20 years focusing on the uninsured, Hispanic American, and young adult populations, and to analyze the factors underlying these changes with a particular focus on the role of health insurance. DATA SOURCES/STUDY SETTING: Data from the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 Medical Expenditure Panel Survey. STUDY DESIGN: Focusing on whether each individual has a usual source of health care, we present descriptive statistics and algebraic decompositions. DATA COLLECTION/EXTRACTION METHODS: We combine data from the household surveys with questions from access to care supplements that were administered each 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 inequalities increased over the period studied and cannot be explained solely by changes in health insurance coverage. CONCLUSIONS: Although increasing health insurance coverage will likely improve access to care among Hispanics and young adults, our findings suggest that the expansion of insurance coverage will not be sufficient to eliminate current disparities in access to care.