Context matters: Where would you be the least worse off in the US if you were uninsured?

Objectives: We examined the health care access, quality, and cost experienced by uninsured Latino mothers in two communities in Minnesota and Texas. These communities differ substantially by the size of the local population without health insurance coverage. Methods: Four focus groups were conducted with uninsured Latino mothers who were caring for at least one child in their household. Seventeen mothers participated in each community. All focus groups were conducted by the same trained staff from a non-profit, community-based research organization. Results: Uninsured Latino mothers in Minnesota rated the quality of health care services in their community to be much higher than their Texas counterparts, but were more likely to emphasize the high costs of care and health insurance coverage. Participants in Texas also described having to go to Mexico to obtain health care services. Conclusions: Policies making provision for health care services to the uninsured are likely to be more effective when they take into account the context or composition of each specific local health care system as well as the financial and non-financial spillovers that these uninsurance-related contexts generate. (C) 2009 Elsevier Ireland Ltd. All rights reserved.