Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We address this gap in the literature by investigating the association between neighborhood residential instability and access to health care. Using individual-level data from the 2000 Medical Expenditure Panel Survey and block-group level data from the 2000 decennial census, we find that individuals who live in neighborhoods with high residential turnover have worse health care access than residents of other neighborhoods. This association persists even when the prevalence of poverty, the supply of health care, and a variety of individual characteristics are held constant. We offer explanations for these findings and suggest directions for future research.
Get full access to this article
View all access options for this article.
References
1.
AndersenRonald M.HongjianYuRobertaWynDavidsonPamela L.BrownRichard E.StephanieTeleki2002.
“Access to Medical Care for Low-Income Persons: How Do Communities Make a Difference?”Medical Care Research and Review59:
384–411
2.
AuchinclossAmy H.Van NostrandJoan F.DonnaRonsaville2001.
“Access to Health Care for Older Persons in the United States: Personal, Structural, and Neighborhood Characteristics.”Journal of Aging and Health13:
329–54
3.
BerkMarc L.ShurClaudia L.CantorJoel C.1995.
“Ability to Obtain Health Care: Recent Estimates from the Robert Wood Johnson Foundation National Access to Care Survey.”Health Affairs14:
139–46
4.
BerkmanLisa F.ThomasGlassIanBrissetteSeemanTeresa E.2000.
“From Social Integration to Health: Durkheim in the New Millennium.”Social Science and Medicine51:
843–57
5.
BillingsJohnAndersonGeoffrey M.NewmanLaurie S.1996.
“Recent Findings on Preventable Hospitalizations.”Health Affairs15:
239–49
6.
BindmanA. B.GrumbachK.OsmondD.KomaromyM.VranizanK.LurieN.BillingsJ.StewartA.1995.
“Preventable Hospitalizations and Access to Health Care.”Journal of the American Medical Association274:
305–11
7.
BrownE. R.WynR.TelekiS.2000.
‘Disparities in Health Insurance and Access to Care for Residents across U.S. Cities.’Commonwealth Fund and UCLA Center for Health Policy Research,
Los Angeles, CA
8.
BrownRichard E.DavidsonPamela L.HongjianYuRobertaWynAndersenRonald M.LidaBecerraNatashaRazack2004.
“Effects of Community Factors on Access to Ambulatory Care for Lower-Income Adults in Large Urban Areas.”Inquiry41:
39–56
9.
CarlisleDavid M.ValdezR. BurciagaShapiroMartin F.BrookRobert H.1995.
“Geographic Variation in Rates of Selected Surgical Procedures within Los Angeles County.”Health Services Research30:
27–42
10.
Center for Health Economics Research.1993.
‘Access to Health Care: Key Indicators for Policy.’Center for Health Economics Research,
Chestnut Hill, MA
11.
CohenJoel1996.
“The Medical Expenditure Panel Survey: A National Health Information Resource.”Inquiry33:
373–89
12.
CohenJoel1997.
‘Design and Methods of the Medical Expenditures Panel Survey Household Component.’Agency for Health Care Policy and Research,
Rockville, MD
13.
ColemanJames C.1988.
“Social Capital in the Creation of Human Capital.”American Journal of Sociology94
(Supplement):
95–120
14.
ColemanJames C.1990.
Foundations of Social Theory.Cambridge, MA:
Harvard University Press
15.
CollinsK. S.HallA.BebusC.1999.
‘U.S. Minority Health: A Chartbook.’Commonwealth Fund,
New York
16.
CrutchfieldR.MichaelGeerkenWalterGove1982.
“Crime Rates and Social Integration: The Impact of Metropolitan Mobility.”Criminology20:
467–78
17.
CunninghamPeter J.GrossmanJoy M.PeterRobert F.LesserCara S.1999.
“Managed Care and Physicians' Provision of Charity Care.”Journal of the American Medical Association281:
1087–92
18.
CunninghamPeter J.KemperP.1998a.
‘The Uninsured Getting Care: Where You Live Matters.’Center for Studying Health System Change,
Washington, DC
19.
CunninghamPeter J.1998b.
“Ability to Obtain Medical Care for the Uninsured: How Much Does it Vary across Communities?”Journal of the American Medical Association280:
921–27
20.
EarpJo AnneEugeniaEngO'MalleyMichael S.MaryAlpeterGarthRauscherLindaMayneMathewsHolly F.LynchKathy S.BahjatQaqish2002.
“Increasing Use of Mammography among Older, Rural African American Women: Results from a Community Trial.”American Journal Of Public Health92:
646–54
21.
FarisRobert E. L.DunhamH. Warren1939.
Mental Disorders in Urban Areas.New York:
Hafner
22.
FreidsonEliot1970.
Profession of Medicine.New York:
Dodd, Mead
23.
FriedmanBernardJoanneJeeClaudiaSteinerArleneBierman1999.
“Tracking the State Children's Health Insurance Program with Hospital Data: National Baselines, State Variations, and Some Cautions.”Medical Care Research and Review56:
440–55
24.
GaskinDarrell J.CatherineHoffman2000.
“Racial and Ethnic Differences in Preventable Hospitalizations across 10 States.”Medical Care Research and Review57:
85–107
25.
GoldsteinHarvey1999.
Multilevel Statistical Models.London:
Arnold Publishers
26.
GrumbachKevinKarenVranizanBindmanAndrew B.1997.
“Physician Supply and Access to Care in Urban Communities.”Health Affairs16:
71–89
27.
HawePenelopeAlanShiell2000.
“Social Capital and Health Promotion: A Review.”Social Science and Medicine51:
871–85
28.
HirschiT.1969.
Causes of Delinquency.Berkeley:
University of California Press
29.
HorwitzAllan1977.
“Social Networks and Pathways to Psychiatric Treatment.”Social Forces56:
86–105
30.
Institute of Medicine.2001.
Crossing the Chasm: A New Health System for the Twenty-First Century.Washington, DC:
National Academy Press
31.
KadushinCharles1966.
“The Friends and Supporters of Psychotherapy: On Social Circles in Urban Life.”American Sociological Review31:
781–802
32.
KadushinCharles1969.
Why People Go to Psychiatrists.New York:
Atherton
33.
KirbyJames B.ToshikoKaneda2005.
“Neighborhood Socioeconomic Disadvantage and Access to Health Care.”Journal of Health and Social Behavior46:
15–31
34.
KomaromyM.LureN.OsmondD.VranizanK.KeaneD.BindmanA. B.1996.
“Physician Practice Style and Rates of Hospitalization for Chronic Medical Conditions.”Medical Care34:
594–609
35.
LevyPaul S.StanleyLemeshow1999.
Sampling of Populations.New York:
John Wiley and Sons
36.
Levy-StormsLeneWallaceSteven P.2003.
“Use of Mammography Screening among Older Samoan Women in Los Angeles County: A Diffusion Network Approach.”Social Science and Medicine57:
987–1000
37.
LongStephen H.MarquisM. Susan1999.
“Geographic Variation in Physician Visits for Uninsured Children.”Journal of the American Medical Association281:
2035–40
38.
MasseyDouglas. S.1996.
“The Age of Extremes: Concentrated Affluence and Poverty in the Twenty-First Century.”Demography33:
395–412
PescosolidoBernice1992.
“Beyond Rational Choice: The Social Dynamics of How People Seek Help.”American Journal of Sociology97:
1096–1138
41.
RoderickP.ClementsS.StoneS.MartinN.DiamondD.1999.
“What Determines Geographic Variation in Rates of Acceptance onto Renal Replacement Therapy in England?”Journal of Health Services Research4:
139–46
42.
RossCatherine E.ReynoldsJohn R.GeisKarlyn J.2000.
“The Contingent Meaning of Neighborhood Stability for Residents' Psychological Well-Being.”American Sociological Review65:
581–97
43.
SampsonRobert J.1985.
“Neighborhood and Crime: The Structural Determinants of Personal Victimization.”Journal of Research on Crime and Delinquency22:
7–40
44.
SampsonRobert J.GrovesW. Byron1989.
“Community Structure and Crime: Testing Social-Disorganization Theory.”American Journal of Sociology94:
774–802
45.
SampsonRobert J.MorenoffJeffrey D.FeltonEarls1999.
“Beyond Social Capital: Spatial Dynamics of Collective Efficacy for Children.”American Sociological Review64:
633–60
46.
SampsonRobert J.RaudenbushStephen W.FeltonEarls1997.
“Neighborhoods and Violent Crime: A Multilevel Study of Collective Efficacy.”Science227:
918–23
47.
ShawClifford R.McKayHenry D.1942.
Juvenile Delinquency and Urban Areas.Chicago, IL:
The University of Chicago Press
48.
Statacorp.2001.
Stata Statistical Software: Release 7.0.College Station, TX:
Stata Corporation
49.
SuchmanEdward A.1964.
“Sociomedical Variation among Ethnic Groups.”American Journal of Sociology70:
319–31
50.
U.S. Department of Health and Human Services.2000.
Healthy People 2010: Understanding and Improving Health.2nd ed.Washington, DC:
U.S. Government Printing Office
51.
WellsB. L.HormJ. W.1998.
“Targeting the Underserved for Breast and Cervical Cancer Screening: The Utility of Ecological Analysis Using the National Health Interview Survey.”American Journal Of Public Health88:
1484–89
52.
ZuvekasSamuel H.TaliaferroGregg S.2003.
“Pathways to Access: Health Insurance, the Health Care Delivery System, and Racial/Ethnic Disparities, 1996–1999.”Health Affairs22:
139
