Community-level uninsurance and the unmet medical needs of insured and uninsured adults

José A. Pagán, Mark V. Pauly

Research output: Contribution to journalArticlepeer-review


Objective. To examine the relationship between community-level uninsurance rates and the self-reported unmet medical needs of insured and uninsured adults in the U.S. Data Sources. 2000-2001 Community Tracking Study, which includes data from 60 randomly selected U.S. communities. The sample is representative of the contiguous U.S. states. Study Design. Multilevel logistic regressions were employed to investigate whether the local uninsurance rate was related to having reported unmet medical needs within the last year. The models also included individual and community variables that could be potentially related to both community uninsurance rates and having reported unmet medical needs. Principal Findings. The community uninsurance rate was positively associated with having reported unmet medical needs, but only for insured adults. On average, a five percentage point increment in the local uninsured population is associated with a 10.5 percent increase in the likelihood that an insured adult will report having unmet medical needs during the 12-month period studied. Conclusion. Local health care delivery systems seem to be negatively affected by high uninsurance rates. These effects could have negative consequences for health care access, even for individuals who are themselves insured.

Original languageEnglish (US)
Pages (from-to)788-803
Number of pages16
JournalHealth Services Research
Issue number3 I
StatePublished - Jun 2006


  • Access
  • Communities
  • Spillovers
  • Uninsured

ASJC Scopus subject areas

  • Health Policy


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