Access to health care: effects of public funding on the uninsured

J Nurs Scholarsh. 2000;32(3):295-300. doi: 10.1111/j.1547-5069.2000.00295.x.


Purpose: To determine whether a state funding policy influenced access to health care for the uninsured in one county of the American Midwest.

Design: The Aday, Andersen, and Fleming (1980) Access Framework guided this descriptive study. The Framework indicates that health policy may directly affect the characteristics of the health care system, which in turn may affect utilization patterns and satisfaction of consumers.

Methods: A descriptive cross-sectional survey in 1996 was used to explore client satisfaction with care at Health Care Access (HCA), the only organization in the county that received funding under a new state policy. HCA's purpose was to provide primary health care to the medically underserved. Satisfaction was measured using an adapted version of the Patient Satisfaction with Health Care Provider Scale (Marsh, 1996). To measure utilization patterns according to insurance status, data were collected to determine visits to the Emergency Department (ED) at the only hospital (LMH) in the county before and after implementation of the state policy. ED data were collected for 1988, 1990, 1993, and 1995; initial funding to HCA began in April 1992.

Findings: Within 3 years after state funding was initiated, uninsured visits to the ED decreased by almost 40%, while insured visits continued to increase. The survey results showed that HCA clients had a high level of satisfaction.

Conclusions: This descriptive study showed that the change in state policy increased access to health care for the medically underserved.

MeSH terms

  • Consumer Behavior
  • Cross-Sectional Studies
  • Financing, Government*
  • Health Policy*
  • Health Services Accessibility* / economics*
  • Humans
  • Medically Uninsured*
  • Midwestern United States
  • State Health Plans
  • United States