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Chapter 3. Access to Health Care
Many Americans have good access to health care that enables them to benefit fully from the Nation's health care system. However, others face barriers that make the acquisition of basic health services difficult. As demonstrated by extensive research and confirmed in the 2003 and 2004 National Healthcare Disparities Reports, racial and ethnic minorities and persons of low SES are disproportionately represented among those with access problems. Poor access to health care comes at both a personal and societal cost: for example, if persons do not receive vaccinations they may become ill and spread disease to others, increasing the burden of disease for society overall, in addition to the burden borne individually.
Components of Health Care Access
Access to health care means having "the timely use of personal health services to achieve the best health outcomes."1 Attaining good access to care requires three discrete steps:
- Gaining entry into the health care system.
- Getting access to sites of care where patients can receive needed services.
- Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust.2
Health care access is measured in several ways including:
- Structural measures of the presence or absence of specific resources that facilitate health care, such as having health insurance or a usual source of care.
- Assessments by patients of how easily they are able to gain access to health care.
- Utilization measures of the ultimate outcome of good access to care—i.e., the successful receipt of needed services.
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How This Chapter Is Organized
This chapter presents new information about disparities in access to health care in America. It is divided into two sections:
- Facilitators and barriers to health care—including measures of health insurance coverage, having a usual source of care and primary care provider, and patient perceptions of need.
- Health care utilization—including measures of receipt of dental care, emergency care, potentially avoidable admissions, mental health care, and substance abuse treatment.
Information about patient-provider communication is found in the section on patient centeredness in Chapter 2, Quality of Health Care. As in previous NHDRs, this chapter focuses on disparities in access to care related to race, ethnicity, and SES in the general U.S. population. Disparities in access to care within specific priority populations are discussed in Chapter 4, Priority Populations. Analyses of changes over time and stratified analyses are also presented within this chapter.
Additionally, this year the NHDR focuses on a narrower set of measures than the full set of measures tracked in previous reports. With guidance from the Interagency Work Groups advising the NHDR and NHQR, this narrower set of core report measures was established. The core report measures aim to be representative of the overall NHDR measure set; but, because they are fewer in number, they are more manageable for policymakers and others to understand and apply when utilizing the NHDR. For details on the process used to establish core report measures, see Chapter 1, Introduction and Methods.
It is primarily core report measures that are presented in the 2005 NHDR and that will be tracked in future iterations of the NHDR. However, the entire NHDR measure set will continue to appear in the appendixes; and, from year to year, supplemental measures (those from the overall NHDR measure set that are not core report measures) will be presented in the text of the NHDR as well. This year's report includes a small number of supplemental measures, though none appear in this chapter.