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An Approach to Obtain a More Complete Picture About Access to Medical Care by U.S. Patient Groups
*Martey S. Dodoo, American Academy of Family Physicians 

Keywords: Access, Insurance groups, Health care Cost

Research Objective: Used nationally representative data to identify patient groups reporting relatively low levels of access to medical care, and determine whether those levels are dwindling. Most past attempts to measure access to medical care services analyzed aggregate insurance groups, ignored cost, affordability, and access to auxiliary medical services like prescription medications. This study aimed at assessing the consequences of these omissions, by carrying out a more comprehensive analysis

Study Design: Analyzed data from 2003 CTS in attempt to replicate earlier studies, and 2001-2006 NHIS to confirm results from CTS and assess if there are any time trends. Created two measures of access in 12 months prior, (1) “Delayed getting medical care because of any of 5 reasons?” (2) Delayed getting care or not get care due to cost. Needed mental healthcare or counseling, or prescription medicine but could not afford them. Analyzed 7 patient insurance groups, trends (2001-2006), and assessed odds of access problems using regression techniques. Population studied: Two nationally representative health surveys (2001-2006 NHIS and 2003 CTS) of U.S. population.

Principal Findings: In 2006, 18.4% disabled Medicare beneficiaries, and 14.4% Medicaid beneficiaries reported barriers to getting needed care, compared to 8.6% privately insured elderly (55-64 years old). 39.1% disabled Medicare beneficiaries, and 21.9% Medicaid beneficiaries also report they could not afford needed auxiliary medical care services like prescription medication, compared to 7.4% privately insured elderly. Similarly 9.9% aged Medicare beneficiaries report having cost and affordability problems. Trends in the proportions lacking access were mostly flat (2001-2006) for the patient subgroups. Odds of someone facing care access barriers are increased almost two fold for the poor, and more than two and half fold for those in poor health.

Conclusions and Policy Implications: Despite results from earlier studies that there are generally no patient access problems, we found many patient groups from two nationally representative samples reporting significant problems in gaining access to medical care. Even though past studies apparently found no access problems for some patients, our more comprehensive analysis unearthed significant barriers for many patient sub-groups. Comprehensive analysis of medical access like that undertaken here is clearly needed for appropriate policy.