Health Care Management Papers

Document Type

Journal Article

Date of this Version

2014

Publication Source

Medical Care Research and Review

Volume

72

Issue

2

Start Page

149

Last Page

167

DOI

10.1177/1077558715569541

Abstract

Insurance expansions under the Affordable Care Act raise concerns about primary care access in communities with large numbers of newly insured. We linked individual-level, cross-sectional data on adult preventive care utilization from the 2011-2012 Behavioral Risk Factor Surveillance System to novel county-level measures of primary care appointment availability collected from an experimental audit study conducted in 10 states in 2012-2013 and other county-level health service and demographic measures. In multivariate regressions, we found higher county-level appointment availability for privately-insured adults was associated with significantly lower preventive care utilization among adults likely to have private insurance. Estimates were attenuated after controlling for county-level uninsurance, poverty, and unemployment. By contrast, greater availability of Medicaid appointments was associated with higher, but not statistically significant, preventive care utilization for likely Medicaid enrollees. Our study highlights that the relationship between preventive care utilization and primary care access in small areas likely differs by insurance status.

Copyright/Permission Statement

This is the post-print version of the article.

Keywords

primary care, access, preventive care, community effects, audit study

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Date Posted: 27 November 2017