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Access to Care

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Access to health care in the mid-1990s varied according to the patient's income level

From the early to the mid-1990s, access to care for young urban adults of middle or higher income improved by 7 percent but declined by 2 percent for lower income individuals, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09569 and HS09446). Blacks also experienced more problems with access than whites, but these differences were largely explained by differences in income. If these trends continue, the already strong disparities in health care access and use may increase between low- and high-income groups in the United States, warns Catarina I. Kiefe, Ph.D., M.D., of the University of Alabama at Birmingham.

Dr. Kiefe and colleagues used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess changes in health care access and use for blacks and whites (who were 25 to 37 years of age) in four areas of the United States during 1992-1993 and again during 1995-1996 (when the subjects were 28-40 years of age). During the first period, 30 percent of the group experienced at least one access barrier, with a decline to 27 percent during 1995-1996. Access improved 7 percent for high-income people but deteriorated 2 percent for lower income individuals. Improved access to care for some groups was probably due to increasing income as young adults aged rather than to the drastic moves toward managed care that occurred across the United States in the 1990s, explain the researchers.

The health care use pattern they observed in 1995-1996 showed more visits to the emergency department (an indicator of poor access to a regular source of care), more hospitalizations, and lower rates of overall outpatient and dental visits for blacks compared with whites, the unemployed compared with the employed, and low-income groups compared with high-income groups. These findings show continued inequities in the system, which result in resource-intensive, probably preventable, acute care (emergency department) visits, a trend the researchers believe is worrisome.

Details are in "Changes in U.S. health care access in the 90s: Race and income differences from the CARDIA study," by Dr. Kiefe, O. Dale Williams, Ph.D., Norman W. Weissman, Ph.D., and others, in the Autumn 2000 Ethnicity & Disease 10, pp. 418-431.

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