Journal of Community Health

, Volume 35, Issue 3, pp 240–248 | Cite as

Beyond Affordability: The Impact of Nonfinancial Barriers on Access for Uninsured Adults in Three Diverse Communities

  • Jeffrey T. Kullgren
  • Catherine G. McLaughlin
original paper


Most proposals to improve access for uninsured adults focus on removing financial barriers to health care. Health services researchers have long recognized, however, that access to care is a multidimensional concept consisting of both financial and nonfinancial dimensions. While financial barriers faced by those without health insurance have been well-documented, it is not known to what degree nonfinancial barriers limit access for those without coverage. In this study we sought to identify the types and frequencies of nonfinancial access barriers faced by low-income uninsured adults, as well as determine how frequently nonfinancial barriers coexist with financial access barriers in this population. We conducted a telephone survey of 1,118 low-income uninsured adults in Alameda, California, Austin, Texas, and Southern Maine who had enrolled in local access programs funded through the Robert Wood Johnson Foundation’s Communities in Charge initiative. Financial barriers were the most often cited barrier to access in each of the three groups, though nonfinancial barriers were often cited as well. Across all three populations, one-third to one-half of respondents with financial access barriers also cited one or more nonfinancial barriers as contributing to their problems accessing health care. Our results suggest that many uninsured adults face nonfinancial health care barriers in addition to their well-documented financial challenges. Health reform efforts must address both types of barriers in order to maximally improve access for the uninsured population.


Uninsured Access to care Nonfinancial barriers Health reform 



This work was supported by a grant from the Robert Wood Johnson Foundation. We thank Leon Wyszewianski for comments on the study framework and John Ayanian for comments on an earlier draft of this manuscript.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jeffrey T. Kullgren
    • 1
    • 2
    • 3
    • 4
  • Catherine G. McLaughlin
    • 5
    • 6
  1. 1.Robert Wood Johnson Clinical Scholars ProgramUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Philadelphia Veterans Affairs Medical CenterPhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Brigham and Women’s Hospital Residency Program in Primary Care and Population Health at Harvard Vanguard Medical Associates and the Department of Population Medicine of the Harvard Pilgrim Health Care InstituteBostonUSA
  5. 5.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  6. 6.Mathematica Policy Research, Inc.Ann ArborUSA

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