Academic journal article Health Care Financing Review

Access to Care and Use of Health Services by Low-Income Women

Academic journal article Health Care Financing Review

Access to Care and Use of Health Services by Low-Income Women

Article excerpt

INTRODUCTION

The Medicaid program is an important source of insurance coverage for low-income women. In 1997, 19.0 percent of low-income women, that is those with incomes below 200 percent of the Federal poverty level (FPL), had Medicaid coverage, 43.1 percent had private coverage, 4.3 percent had other public coverage, and 33.6 percent were uninsured (Figure 1). (In 1997, 200 percent of the FPL was approximately equal to $26,000 for a family of three.) Eligibility for Medicaid has his torically been limited to those receiving Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI), pregnant women, and the medically needy. A number of States have made special efforts to provide Medicaid coverage to other adults through research and demonstration waivers granted under section 1115 of the Social Security Act. However, these States are the exception to the rule. Consequently, Medicaid's role is especially critical for poor women and for pregnant women. In 1997, Medicaid covered almost one-third of all poor women and financed the deliveries for more than one-third of all births nationally (National Governor's Association, 2000).

Figure 1
Health Insurance Coverage of Low-Income Women

Low-Income Women

Medicaid       19%
Other Public    4%
Private        43%
Uninsured      34%

Poor Women

Medicaid       32%
Other Public    4%
Private        26%
Uninsured      38%

NOTES: Low-income women include those with family incomes
200 percent of the Federal poverty level. Poor women include those
with incomes below the Federal poverty level. Insurance coverage is
measured at the time of the survey.

SOURCE: Author's tabulations of data from the 1997 National Survey
of America's Families.

Note: Table made from pie graph.

To address the complex and diverse health needs of this low-income population, the Medicaid benefit package is relatively broad and has limited cost-sharing. Among the services States are required to provide under their Medicaid programs are inpatient and outpatient care, laboratory and X-ray services, physician, nurse midwife, and nurse practitioner services, and family planning services. Optional services include dental care and prescription drugs, among others (Congressional Research Service, 1993).

Despite this breadth of coverage, concern about access to care under the Medicaid program is longstanding. Low reimbursement rates, administrative burdens, and residential segregation between providers and patients have been cited historically as factors that contribute to access problems for those covered by Medicaid (Sloan, Mitchell, and Cromwell, 1978; Mitchell, 1991; Fossett et al., 1992; Dubay et al., 1995). At the same time, Medicaid beneficiaries are consistently found to use more services than both the uninsured and the privately insured (Freeman and Corey, 1993; Marquis and Long, 1996).

Surprisingly, little attention has been paid to access issues for low-income women with private coverage. Most of these women receive coverage through their employer or their spouse's employer, while others purchase coverage in the non-group market. Low-income women with private coverage often face deductibles, copayments, and limited coverage of preventive and other benefits, which may also affect access to care and use of services. Understanding how low-income women fare is important, given the large share of women with private coverage.

Finally, almost one-third of low-income women are uninsured. These women must rely on the safety net, pay for services out of their own pockets, or forgo needed care. To the extent that these women are generally in good health, are able to obtain preventive and other services, and have little unmet need, then perhaps they should not be much of a policy concern. If, however, these women do have unmet need and are not appropriately accessing services, they may be an important target for expansions in coverage. …

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