For well over a decade, providing sufficient health care to all Americans has been one of the hottest political topics in the United States.  Currently, more than 40 million Americans are uninsured.  The proportion of Americans without health insurance increased last year by the largest number in a decade, bringing the total number without coverage to 43.6 million (U.S. Census, 2003 estimates).   Data reveals that the U.S. economy loses between $65 billion and $130 billion every year when people without health insurance get sick and die early (Institute on Health, Reuters Health, 2003). The health of individuals and communities depends greatly on access to quality health care.  Having health insurance and a primary care provider or other source of ongoing care are strong predictors of access to quality care.  Persons with health insurance are more likely to have a primary care provider and to receive appropriate preventive care. 

Barriers to accessing health care include not having insurance or not having enough insurance to cover needed services.  Currently, about two-thirds of Americans have health insurance through an employer or a family member's employer. The poor, disabled and those older than age 65 mostly rely on Medicare and Medicaid, but many Americans--an estimated 18.5 percent of those between 18 and 65--had no coverage for all or part of the past year (Institute on Health, Reuters Health, 2003). Persons without coverage for basic health care necessities, such as prescriptions or dental care, and who lack sufficient resources to pay for these items out-of-pocket, often do not receive appropriate care until their condition is series.  This, in turn, places additional burden on the patient, the community and the health care system. 

The following article examines access to care among adults 18 years of age and older in Southeastern Pennsylvania.  The data presented are from PHMC’s 2002 SEPA Household Health Survey.

Access to A Primary Health Care Provider

More than one-quarter of a million adults (319,500) in Southeastern Pennsylvania do not have one place or person they usually go to when they are sick or want advice about their health.  This number represents 11.1% of adults in the region.  Southeastern Pennsylvania is more than twice as high as the Healthy People 2010 objective of 4%.  Certain subgroups are more likely to lack a primary health care provider.

• Male adults are more likely to not have a regular source of care compared to females (13.9% versus 8.6%).
• Younger adults ages 18-39 are more than twice as likely to not have a regular source of care (17.4%) compared to adults ages 40-64 (7.8%), and those 65+ (5.2%).
• Not surprisingly, poor adults are more likely to lack a regular source of care compared to the non-poor (14.4% versus 10.3%, respectively).
• More than one-quarter (26.1%) of Latino adults do not have a regular source of care and slightly more than one out of five Asian adults do not have a regular source of care (21.8%).  One out of ten white (10%) and black (9.9%) adults do not have a regular source of care. 

Health Insurance Status

Greater than 211,500 adults in Southeastern Pennsylvania, or 7.3% of adults, do not have any public or private health insurance.  This does not yet meet the Healthy People 2010 objective of 0%.  The percentage of uninsured adults in SEPA has increased slightly from 6.3% in 1991 to 7.3% in 2002. 

• Male adults are slightly more likely to be uninsured compared to females (8.4% versus 6.4%, respectively).
• Younger adults age 18-39 are more than twice as likely to be uninsured (12.6%) compared to adults ages 40-64 (5.5%), and those 65 years and older (.4%)
• The poor are almost three times as likely to be uninsured compared to the non-poor (17.3% versus 6.1%, respectively)
• Latino adults are more likely to be uninsured (20.5%) compared to Asian (14 .2%), black (10.6%) or white (5.3%) adults.
• In SEPA, 5.5% of adults who are employed full time are uninsured; this percentage represents 84,300 adults.  One out of seven adults who are employed part time are uninsured.

Insurance Coverage for Prescriptions and Dental Care

More than one out of ten insured adults (12.4%) lacks coverage for prescription medications, representing 332,700 adults.  More than one-quarter (27.8%) of insured adults, representing 743,300 persons who do not have dental care coverage.

• More than one out of five older adults 65 years of age and older do not have prescription coverage (23.9%); this percentage represents 124,800 older adult without this coverage.  Older adults are two times as likely to lack prescription coverage compared to younger adults age 18-39 (11.7%) and adults ages 40-64 (8.0%).
• The poor are almost twice as likely to lack prescription coverage compared to the non-poor (20.3% and 11.6%, respectively).
• One out of five Asian adults (20.8%) do not have prescription coverage followed by Latino (15.4%), black (13.5%) and white (11.6%) adults.
• Six out of ten (60.2%) older adults age 65 years and older do not have dental coverage compared to approximately one out of five adults ages 40-64 (21.0%) and adults 18-39 (18.6%).  
• The poor are more likely to lack dental coverage (34.2%) compared to the non-poor (27.1%).

The findings show that a considerable number of adults in the Southeastern Pennsylvania do not have a regular source of health care, lack health insurance coverage, and lack prescription or dental coverage.  These individuals often do not seek care until a health condition becomes series, placing additional burden on our region’s health care delivery system.  The findings underscore the need to provide access to care for all individuals.  For more information on access to care, please contact Francine Axler at Francine@phmc.org.