Insurance, income, and access to ambulatory care in King County, Washington

UMMS Affiliation

Meyers Primary Care Institute; Department of Family Medicine and Community Health

Publication Date


Document Type



Adolescent; Adult; Aged; Ambulatory Care; Child; Data Collection; Female; Health Services Accessibility; Humans; Income; Insurance, Health; Linear Models; Male; Medicaid; Medically Uninsured; Middle Aged; Odds Ratio; Preventive Health Services; United States; Washington


Health Services Research | Primary Care | Public Health


OBJECTIVES: We studied simultaneous effects of income and insurance on access measures in an indigent population, focusing on Medicaid and the marginal effects of increasing income.

METHODS: Surveys were distributed in waiting rooms of county clinics and welfare offices. Models examined insurance (private, Medicaid, or none), income (to twice the poverty level), single-parent status, age, gender, and presence of a regular source of care; first-order interactions were evaluated.

RESULTS: In terms of ease of access, postponing care, and having a regular source of care, uninsured respondents fared worst and Medicaid recipients were at an intermediate level. However, relative to those with private insurance, Medicaid recipients had four times the odds, and uninsured respondents twice the odds of being denied care. Income had no consistent effect; however, older, poorer people may have greater problems. For preventive services, income was significant, while differences between Medicaid and private insurance were generally not significant.

CONCLUSIONS: Except for denial of care, access for indigent people is improved by Medicaid but remains worse than the access of those with private insurance. Income had variable effects, but support for income criteria used for public insurance eligibility was not found.


Am J Public Health. 1993 Nov;83(11):1583-8.

Journal/Book/Conference Title

American journal of public health


At the time of publication, Barry Saver was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID