Improving Access Through Health Insurance Coverage and Safety Net Expansion: A Review of the Literature

This policy brief reviews the literature on access to health care as it relates to current proposals for health care reform in California. To draw their conclusions, the authors of the publication reviewed existing literature on the expansion of primary health care centers versus the expansion of health insurance. Additionally, the authors analyzed data from the 2005 California Health Interview Survey to determine current levels of insurance, usual source of care, and how the two relate to each other. The authors found that: Expanding the health care safety net has been shown to improve access to care by providing a usual source of care or "medical home" and providing enabling services such as child care, transportation, interpreter services, and case management. However, while many uninsured Californians are able to access primary care through community clinics and health centers, specialty services are not readily available. Having health insurance is associated with better health status and improved access to care. Still, health insurance alone is not sufficient to guarantee access to necessary services, especially in light of recent market trends toward high-deductible health plans, reductions in benefits, and greater patient cost sharing. In order to significantly reduce the barriers to access faced by Californians, the expansion of health insurance and primary care centers will have to happen together. Support for this study was funded by a grant from The California Endowment.

Publication Authors:

• Dylan H. Roby, PhD
• Gerald F. Kominski, Ph.D.
• Meghan E. Cameron