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Highlights #3: Access to Health Care in America, 1996
Estimates for the U.S. Civilian Noninstitutionalized Population
Introduction
Having adequate access to health care
services can significantly influence health care use and health
outcomes. Consequently, measures of access to care provide an
important mechanism for evaluating the quality of the Nation's
health care system. Limitations in access to care extend beyond
such simple causes as a shortage of health care providers or
facilities in some areas. Even where health care services are
readily available, individuals may not have a usual source of
health care or may experience barriers to receiving services
due to financial or insurance restrictions, a lack of availability
of providers at night or on weekends, or other difficulties.
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Briefly
Stated
- 18 percent of the population had no usual
source of health care in 1996. This represents more than 46
million Americans who had no particular doctor's office, clinic,
health center, or other place where they would usually go if
they were sick or needed advice about their health.
- 1996, the groups most likely to lack a usual
source of health care included Hispanic Americans (30 percent),
the uninsured under age 65 (38 percent), and young adults ages
18-24 (34 percent).
- 12 percent of
all American families (12.8 million families) experienced
barriers to receiving needed
health care services. When asked the main reason for their
difficulty, delay, or inability to obtain needed care, 60 percent
of these families cited the inability to afford medical care
and 20 percent cited insurance-related problems.
- in which one
or more members lacked health insurance were about two to
three times more likely to have
experienced barriers to receiving needed health care services
than families in which all members were insured.
Americans under age 65 who were uninsured
were substantially more likely to lack a usual source of health
care (38 percent) than those who had either private (15 percent)
or public health insurance (13 percent), as shown in Figure
2. Persons under age 65 who had private insurance were more
likely to have an office-based usual source of care (77 percent)
than those who had only public insurance (71 percent) or were
uninsured (52 percent). Americans age 65 and over who had Medicare
as their only health insurance coverage were more likely to lack
a usual source of health care (12 percent) than persons with
Medicare plus private insurance coverage (8 percent).
Among the 12 percent
of American families with members who changed their usual source
of health care in
the past year, 25 percent switched for insurance-related reasons
and 19 percent changed because they were dissatisfied with their
quality of care (Figure 3).
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Usual
Source of Health Care
Hispanics (30 percent)
were the least likely of all racial/ethnic groups to have a usual
source of health care (Figure 1). Blacks
(16 percent) and Hispanics (13 percent) were more likely than
the group of whites and others (8 percent) to have hospital-based
providers as their usual source of care.
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Barriers
to Needed Health Care
Families headed by Hispanic individuals were
more likely to report barriers to receiving health care (15 percent)
than families whose head was black (10 percent) or white or other
race/ethnicity (11 percent), as shown in Figure
4. Among families who encountered problems in receiving care,
those headed by Hispanics were more likely (69 percent) than
those headed by persons who were white or other race/ethnicity
(59 percent) to report being unable to afford health care.
Among American families in which one or more
members were uninsured, 23 percent reported difficulty, delay,
or not receiving the health care they needed (Figure
5). Of these families, 83 percent, or nearly 5 million families,
identified the inability to afford care as their main barrier.
Only 7 percent of families in which all members were privately
insured reported barriers to care. Even in the privately insured
group, more than two-thirds of the families experiencing barriers
to care cited affordability or health insurance problems as the
main reason for their difficulty.
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Medical
Expenditure Panel Survey
The Medical Expenditure Panel Survey (MEPS)
collects nationally representative data on health care use, expenditures,
source of payment, and insurance coverage for the U.S. civilian
noninstitutionalized population. MEPS is cosponsored by the Agency
for Health Care Research and Quality (AHRQ) and the National
Center for Health Statistics. This Highlights summarizes several
aspects of access to health care in the United States during
1996, as derived from the MEPS Household Component, Rounds 1
and 2.
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Figures
Figure
1. Race/ethnicity and usual source of care: 1996
- Overall, about 18
percent of the population had no usual source of care.
DATA SOURCE:
1996 Medical Expenditure Panel Survey Household Component, Rounds
1 and 2
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Figure 2. Health
insurance and usual source of care: 1996
- About 38 percent of
uninsured people under age 65 had no usual source of care.
DATA
SOURCE: 1996 Medical Expenditure Panel Survey Household Component,
Rounds 1 and 2
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Figure 3. Reasons
for changing usual source of health care: 1996
- About 12 percent of
American families had at least one family member who had changed
his or her usual source of care during the past year.
DATA SOURCE: 1996 Medical
Expenditure Panel Survey Household Component, Rounds 1 and 2
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Figure 4. Race/ethnicity
of head of family and barriers to health care: 1996
- About 12 percent of
American families experienced difficulty or delay in obtaining
care or did not receive health care that they needed. Barriers
were reported by 15 percent of Hispanic families, 10 percent
of black families, and 11 percent of the white and other group.
DATA SOURCE: 1996 Medical
Expenditure Panel Survey Household Component, Rounds 1 and 2
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Figure 5. Family
health insurance status and barriers to health care: 1996
- Barriers were reported
for 23 percent of families with one or more uninsured members
but only 7 percent of families with all members privately insured.
Barriers were reported by 12 percent of families with public
insurance and 13 percent with mixed private and public insurance.
DATA SOURCE: 1996 Medical Expenditure
Panel Survey Household Component, Rounds 1 and 2
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References
For more information on MEPS, call the MEPS
information coordinator at AHRQ (301/594-1406) or visit the MEPS
section of the AHRQ Web site at http://www.ahrq.gov/
For a detailed description of the MEPS survey
design, sample design, and methods used to minimize sources of
nonsampling error, see the following publications:
Cohen J. Design and methods of the Medical
Expenditure Panel Survey Household Component. Rockville (MD):
Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 1. AHRQ Pub. No. 97-0026.
Cohen S. Sample design of the 1996 Medical
Expenditure Panel Survey Household Component. Rockville (MD):
Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 2. AHRQ Pub. No. 97-0027.
The estimates in this Highlights are based
on the following, more detailed report:
Weinick RM, Zuvekas SH, and Drilea SK. Access
to health care--sources and barriers: 1996. Rockville (MD): Agency
for Health Care Policy and Research; 1997. MEPS Research Findings
No. 3. AHRQ Pub. No. 98-0001.
MEPS Highlights
No. 3, AHRQ Pub. No. 98-0002, October 1997.
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Suggested Citation:
Highlights #3: Access to Health Care in America, 1996. October 1997. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.meps.ahrq.gov/data_files/publications/hl3/hl3.shtml |
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