Access to Care in the USA

Main Category: Public Health
Article Date: 28 Feb 2004 - 0:00 PDT

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National Center for Health Statistics

Access to care is important for preventive care and for prompt treatment of illness and injuries. Indicators of access to health services include having a usual source of health care and having a recent health care contact.

Health insurance coverage, and the generosity of coverage, are major determinants of access to care.

The percent of the population under 65 years of age with no health insurance coverage (either public or private) fluctuated around 16-17 percent between 1994 and 2001. Among the under 65 population, poor and near poor persons whose family incomes were less than 200 percent of poverty were much more likely than others to be uninsured.

The likelihood of being uninsured varies substantially among the States. In 2001 the percent of the population under 65 years of age with no health insurance coverage varied from less than 10 percent in Massachusetts, Rhode Island, Wisconsin, Iowa, and Minnesota to 20 percent or more in Florida, Louisiana, Oklahoma, Texas, Arizona, New Mexico, and California.

In 2001, 11 percent of children under 18 years of age had no health insurance coverage. Between 2000 and 2001 among children with family income just above the poverty level (1-1.5 times poverty), the percent uninsured dropped from 26 to 19 percent.

However children with low family income remain substantially more likely than higher-income children to lack coverage.

Persons of Hispanic origin and American Indians who are under 65 years of age are more likely to have no health insurance coverage than are those in other racial and ethnic groups.

In 2001 among the Hispanic-origin population, persons of Mexican origin were the most likely to lack health insurance coverage (39 percent). Non-Hispanic white persons were the least likely to lack coverage (12 percent).

Six percent of children under 18 years of age had no usual source of health care in 2000-01. Hispanic and non-Hispanic black children were more likely to be without a usual source of care than non-Hispanic white children (14 percent and 7 percent compared with 4 percent).

Thirteen percent of children under 18 years of age had no health care visit to a doctor or clinic within the past 12 months in 2000-01. Hispanic and non-Hispanic black children were more likely to be without a recent visit than non-Hispanic white children (20 percent and 15 percent compared with 10 percent).

Onein5 children under 18 years of age had an emergency department (ED) visit within the past 12 months in 2001. Children with Medicaid coverage were more likely than those with private coverage or the uninsured to have had an ED visit within the past 12 months (29 percent compared with 19 percent and 17 percent).

In 2001 nearly three-quarters of children 2-17 years of age had a dental visit in the past year. Use of dental care was lower among Hispanic children and non-Hispanic black children than among non-Hispanic white children (61 percent and 68 percent compared with 78 percent).

Young adults 18-24 years of age are more likely than adults of other ages to have no usual source of health care. Twenty-six percent of young adults were without a usual source of health care in 2000-01.

Working age-adults 18-64 years of age living below the poverty level were more than twice as likely as those with family income above twice the poverty level to have no usual source of health care in 2000-01 (27 percent and 12 percent).

Among working-age adults living in poverty Hispanic persons were twice as likely as non-Hispanic white and black persons to be without a usual source of health care (44 percent compared with 22 percent and 21 percent) (percents are age adjusted).

Use of hospital inpatient care is greater among the poor than among the nonpoor whose family income is at least twice the poverty level. In 2001 among persons under 65 years of age, the hospital discharge rate for the poor was almost twice the rate for nonpoor (168 and 87 per 1,000 population).

Among those under 65 years of age, average length of stay was 1.4 days longer for poor than for nonpoor persons (5.1 and 3.7 days) (data are age adjusted).

In 2001 among noninstitutionalized persons 65 years of age and over, those with Medicare fee-for-service coverage only were more likely to have had no health care visits within the past 12 months than were those with Medicare HMO, Medicaid, or private coverage (14 percent compared with 5-6 percent, data are age adjusted).

In 2001 among noninstitutionalized persons 65 years of age and over, those with Medicaid coverage were twice as likely to be high volume users of the health care system with 10 or more visits within the past 12 months than were those with Medicare HMO, private, or Medicare fee-for-service coverage only (44 percent compared to 21-25 percent, data are age adjusted).