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Increasing Access to Health Care Return to Informing the Health Care Debate »
Access to health care usually refers to the ease with which an individual can obtain needed medical services. In addition to policy options that would increase the availability of insurance coverage – which is linked to improved access to needed care – Congress is considering options for addressing socioeconomic and urban/rural disparities in access, including tax incentives and policy options to address primary care workforce issues. RAND research has examined factors that influence access, the effects of changes in access, and the relationship between access and health for specific populations, including racial and ethnic minorities, people with limited English proficiency, immigrants, children, and veterans.
The Uninsured
The importance of health insurance in obtaining health care and ensuring health has been documented for several decades, as have the negative effects of going without it — declines in access to care as well as poorer health.
TopUrban/Rural Disparities
Access to health care among the uninsured in urban areas is related to the percentage of patients who are uninsured, the supply of primary care physicians, the safety net capacity, and the competitiveness of managed care.
Uninsured children in rural areas are more likely to receive some type of medical services if they live closer to "safety net" providers or if there are more primary care physicians nearby.
Racial/Ethnic Disparities
Racial and ethnic minorities are fundamentally at greater risk of ill health than their nonminority, nonpoor, better educated peers. Health care and social factors associated with such disparities relate directly to access to care; however, erasing disparities in health cannot be accomplished simply by achieving universal access to care. Policies that affect public health and the nonmedical determinants of health are also necessary.
Older adults with limited English proficiency experience worse access to care and worse health status than their English-speaking counterparts.
Immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups, including factors such as socioeconomic background and English proficiency.
Children
High-quality primary care for children requires more than insurance: access to a regular medical care provider and receipt of care when it is needed are also critical.
Vulnerable children who have the greatest health care needs also have the greatest difficulty obtaining access to a regular source of primary care.
Low-income children who received improved primary care access through SCHIP also experienced improved health-related quality of life over a two-year period.
A survey of parents in Los Angeles about their children's primary care experiences found that access to a regular source of care had a greater effect on their experience than whether their child had insurance.
Veterans
As many as 20 percent of U.S. servicemembers returning from deployment to Iraq and Afghanistan report symptoms consistent with depression and posttraumatic stress disorder, but face substantial barriers to accessing mental health care, including privacy concerns, fear of stigma, and a lack of trained providers.
