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Millions Face Barriers To Obtaining Medical Care

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Press Release Date: November 26, 1997

Nearly 13 million of the roughly 110 million families in the United States—11.6 percent of all families—experienced difficulty or delays in obtaining medical care or did not get the care they needed during 1996, according to new estimates from the Federal Agency for Health Care Policy and Research (AHCPR).

The most common barrier, experienced by 7.6 million families or roughly 60 percent of all those reporting difficulty with access, was not being able to afford care they needed. Other barriers included insurance-related problems, such as not being able to get referrals, transportation problems, or not being able to get child care.

Uninsured families were more likely than the average family to experience problems obtaining needed health care. More than 27 percent of them, or 3.3 million uninsured families, experienced barriers, including the inability to afford care. Hispanic families were more likely than white or black families to encounter problems. Roughly 1.4 million Hispanic families (15 percent of all Hispanic families) reported barriers. For almost seven in 10 of these Hispanic families, the problem was the cost of health care.

"These new estimates clearly indicate that access to care continues to be a significant problem," said HHS Secretary Donna E. Shalala. "By increasing the availability of health insurance for children, and instituting new reforms to help people take insurance with them when they change jobs, we have taken important steps to address these issues. Yet too many of our citizens lack basic access to health care."

In addition, more than 46 million Americans had no usual source of health care in 1996. This means nearly 18 percent of the population 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. This figure is relatively unchanged from AHCPR estimates made from 1987 data.

The groups most likely to be without a usual source of health care were uninsured persons under age 65 (16.7 million, or 38 percent of this group), young adults ages 18 to 24 (8.5 million, or 34 percent of young adults), and Hispanics (8.4 million, or 30 percent of Hispanics). Young children and the elderly were more likely than adults under age 65 to have a usual source of care. Even so, there were 1.3 million children under age six and 2.9 million persons age 65 and older with no usual source of care.

"This is significant because people without a usual source of care may be less likely to receive treatment in a timely manner and to receive preventive health care services," said AHCPR Administrator John M. Eisenberg, M.D. Dr. Eisenberg said that without a personal physician or other usual source of care, patients are missing an advocate to help them make important health care decisions.

Among the 82 percent of Americans who did have a usual source of care, nearly 9 of every 10 said they used office-based providers and the rest said they got their care from hospital outpatient departments, clinics, or hospital emergency rooms. The most commonly used office-based providers were group or clinic practices and family or general practitioners.

The Balanced Budget Act of 1997 created a new Federal-State Children's Health Insurance Program under Title XXI of the Social Security Act. This program sets aside $24 billion over 5 years for states to initiate and expand health insurance coverage for uninsured children. The Health Insurance Portability and Accountability Act of 1996 is designed to improve the availability of health insurance to working families and their children. It includes important new protections for an estimated 25 million Americans who move from one job to another, who are self-employed, or who have pre-existing medical conditions.

Estimates are from the 1996 Medical Expenditure Panel Survey (MEPS). AHCPR designed MEPS—the successor to its National Medical Expenditure Survey—to provide policymakers and others with up-to-date, highly detailed information on how Americans as a whole, as well as different segments of the population, use and pay for health care. This ongoing survey also looks at insurance coverage and other factors related to access to health care.

Detailed findings are in Access to Health Care in America—1996, MEPS Highlights 3 (AHCPR Pub. No. 98-0002) and Access to Health Care in America—Sources and Barriers: 1996, MEPS Research Findings 3 (AHCPR Pub. No. 98-0001), which includes detailed tables. Both publications are available from the AHCPR Publications Clearinghouse by calling 1-800-358-9295 or writing to P.O. Box 8547, Silver Spring, MD 20907. The publications also are available through AHCPR's MEPS web site at, as are microdata files for persons wishing to conduct their own data analyses. Visit the AHCPR web site for other information on the Agency and its programs.

For additional information, contact AHCPR Public Affairs; Karen Carp, (301) 427-1858 (; Salina V. Prasad, (301) 427-1864 (

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