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Health Care, Access

Several indicators measure the level of access to health care. Among these, typically using a 12-month period of focus, are an individual's health care coverage and whether or not an individual saw or spoke to a doctor or visited an emergency room. In addition, determining who uses certain preventative health care, like dental services, prescription drugs, mammo-grams, cancer screenings, and pap smears, also gauges health care access.

Among adults ages 18 to 64, about 17 percent have no usual source of health care. In a given year, about 16 percent of adults do not see a doctor, visit an emergency room, or have home health care. About 20 percent of Americans ages 18 to 64 visit the emergency room once, and 7 percent visit it 2 or more times. Two thirds of adults see a dentist annually, 70 percent of women over the age of 40 have a mammogram once every 2 years, and 79 percent of women over the age of 18 have a pap smear once every 3 years.

Disparities in Health Care Access

Health care is stratified by certain social characteristics, especially race and social class. Nonwhites are less likely to have a regular source of health care. Hispanics—in particular, Mexicans—have the highest percentage of noncoverage: Almost one third do not have a regular health care provider. Blacks and Native Americans are more likely than whites to have used the emergency room in the past 12 months. Members of all racial minority groups are less likely than whites to have seen a dentist in the past 12 months. Minorities, especially blacks, are less likely to have invasive cardiac procedures, even when their insurance and illness characteristics are the same as those of whites.

Substantial percentages of the poor (23 percent) and near poor (22 percent) have no usual source of medical care. By contrast, 14 percent of the nonpoor have no usual source of medical care. One in five poor adults report they did not see a doctor, visit an emergency room, or receive home health care in the past year. The poor and near poor are more likely to use the emergency room than a doctor's office as their main source of medical care, especially when they qualify for Medicaid. Thirteen percent of the poor and 10 percent of the near poor have visited an emergency room in the past year compared with only 5 percent of the nonpoor. Among those with Medicaid, almost 40 percent have been to an emergency room at least once, and 22 percent have been at least twice in a given year. Poor adults are also less likely to have access to preventative care, like dental services, prescription drugs, mammograms, cancer screenings, and pap smears.

Determinants of Health Care Access

Health insurance coverage and lack thereof largely determine access. In 2007, 44.8 million Americans were uninsured, most of them with little or no access to health care. Forty-seven percent of uninsured adults had no regular source of health care within the past year, and 38 percent had no health care visits in a 12-month period. This percentage is 3 times that of the insured population. Adults without insurance are also less likely to get preventative services, like regular mammograms or pap smears.

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