1 in 7 Americans in 2003 faced problems getting needed medical care

Despite sluggish economic growth and rapidly rising health care costs, Americans' access to needed medical care improved slightly between 2001 and 2003, especially among low-income children and adults, according to a national study released today by the Center for Studying Health System Change (HSC).

Nonetheless, nearly 14 percent of the U.S. population, or about 39 million people, reported going without or delaying needed medical care in 2003, according to findings from HSC's 2003 Community Tracking Study Household Survey, a nationally representative survey involving information on about 25,400 families and 46,600 people. Almost 15 million Americans reported going without needed medical care at some point in the previous 12 months, and another 24 million Americans delayed care.

The proportion of Americans reporting an unmet medical need between 2001 and 2003 declined by 0.5 percentage points to 5.2 percent—the equivalent of about 1 million fewer people going without needed care. During the same period, the proportion of Americans who reported delaying care declined by 1.1 percentage points to 8.4 percent, or about 2 million fewer people postponing care.

Uninsured people continued to face far greater access problems and were more than three times as likely to report going without care as insured people—13.2 percent vs. 3.9 percent. Nevertheless, decreases in unmet need between 2001 and 2003 were concentrated among vulnerable groups. The proportion of uninsured people with incomes less than 200 percent of poverty—$36,800 for a family of four in 2003—with an unmet need decreased by 3.2 percentage points to 13.2 percent in 2003.

"Initiatives at the federal, state and local levels to support health care safety net providers—an important source of care for low-income and uninsured people—likely contributed to the modest improvements in access to medical care," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Increased federal aid to communities through the Community Access Program and Community Health Center (CHC) expansion grants have encouraged improved coordination among safety net providers and allowed many CHCs to create new facilities and expand services, Ginsburg said.

While access to care fluctuated for the overall U.S. population between 1997 and 2003, children's access to care improved steadily during this time, particularly for low-income children. In 2003, only 2.2 percent of all children did not get the medical care they needed, and another 2 percent delayed care. The most notable improvements in access to medical care occurred for low-income children, likely reflecting growth in public insurance coverage. The percentage of low-income children with unmet medical needs declined by more than half between 1997 and 2003—from 4.6 percent to 2.2 percent.

"The improvement in access for low-income children eliminated long-standing income-related disparities in access to care," said HSC Health Researcher Bradley C. Strunk, who co-authored the study with HSC Senior Health Researcher Peter J. Cunningham, Ph.D.

In 1997, low-income children were about twice as likely as children in higher-income families to experience an unmet need, but by 2003 that gap had closed, with 2.2 percent of both groups reporting an unmet need.

The study's findings are detailed in a new HSC Tracking Report—Trends in Americans' Access to Needed Medical Care, 2001-2003. Other key findings include:

• People who reported fair or poor health remained almost three times as likely to go without needed care as people who reported their health was good or excellent—11.9 percent vs. 4.1 percent in 2003.
• Uninsured people in fair or poor health reported the greatest problems getting needed care in 2003, with one in four (24.5%) reporting they went without needed care.
• For people reporting an access problem, cost was the most frequently cited—and a growing—barrier to care. In 2003, 65.2 percent of people who went without or delayed needed care cited worries about cost, a 2.8 percentage point increase from 1997. Most of the change occurred between 2001 and 2003.
• Between 2001 and 2003, the frequency with which insured people cited a health plan-related reason for going without or delaying care declined by 2.9 percentage points to 30.5 percent in 2003. Most of the decline was attributable to people reporting fewer problems getting their health plan to pay for treatment.

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