Routine and timely health care, including preventive health screenings, can prevent higher treatment costs for patients and help to reduce mortality and morbidity for some chronic diseases. Having a regular primary care provider is also associated with greater patient trust in their provider, and correlates with receiving of higher quality care. According to the Agency for Healthcare Research and Quality (AHRQ), only 70% of the non-institutionalized population in the U.S. visits a health care provider each year, and 13% of Americans (including children, adults and seniors) have no specific source of ongoing health care. Furthermore, nearly one in ten families are unable to receive, or are delayed in receiving, needed medical care each year.

In recognition of “Take A Loved One for a Check-up Day” this September 19th, the following article presents information from PHMC’s 2006 Household Health Survey on routine care and access to health services in the five-county Southeastern Pennsylvania (SEPA) region.

REGULAR SOURCE OF CARE

The 2006 Household Health Survey results indicate that in 2006, 10.1% of adults in SEPA did not have a regular source of care; this represents about 297,000 people who did not have a usual medical office or place to go when they were sick or wanted advice about their health. In addition it was found that:

- Men (13.1%) were more likely than women (7.5%) to have no regular source of care.

- Younger adults were less likely to have a regular source of care than older adults.  Among 18-39 year olds, 16.2% had no regular source of care, followed by 40-49 year olds (8.4%), 50-59 year olds (6.6%), 60-74 year olds (5.7%), and those 75 and older (5.3%).

- Of the five counties in SEPA, Philadelphia had the highest percentage of adults with no regular source of care (11.8%), and Bucks County had the lowest percentage (8.1%).

- 15.2% of adults in SEPA had not had a medical check-up in the last year; this percentage represents about 450,000 people who did not receive annual routine and preventive care.

DISPARITIES IN ACCESS TO ROUTINE CARE

Research has demonstrated that racial and ethnic minorities and persons of low socioeconomic status disproportionately lack access to routine care. Nationwide, the proportion of people with a regular primary care provider is significantly lower among Hispanic/Latino, Black/African-American, and Asian populations than among White populations. The proportion of people with a regular source of care is also significantly lower among the poor compared to the non-poor. In SEPA, disparities in routine care mirror national statistics.

- A greater proportion of White adults had a regular source of care than was found among other racial/ethnic groups in 2006. For example, 20.1% of Latino adults, but only 8.8% of White adults, reported having no regular source of care (Figure 1).

- Adults living below the federal poverty level (13.7%) were more likely to lack a regular source of care than adults living above the federal poverty level (9.6%). 

BARRIERS TO ROUTINE CARE

In addition to measuring access to routine care, the Household Health Survey also assesses barriers to health care access. Transportation, cost of care, and lack of health insurance can hinder access to timely and routine health care.

- 6.4% of adults reported canceling a doctor’s visit due to transportation problems, which represents over 188,000 adults in the region. Black (13.4%) and Latino (13.1%) adults were almost four times as likely to experience transportation barriers to care than White adults (3.6%).

- Almost one-in-ten adults (9.1%) did not seek medical care when they were sick due to the cost, which represents over 268,000 adults. Black (9.9%) and Latino (15%) adults were more likely than White adults (7.9%) to report cost as a barrier to receiving health care. 

- Almost 34% of uninsured adults but only 8.1% of insured adults (aged 18-64) had no regular source of care (Figure 2). In addition, uninsured adults (18-64) were much less likely than insured adults to have visited a doctor in the past year (61.3% and 86.7%, respectively).

SUMMARY

Findings presented in this article indicate that the majority of adults in Southeastern Pennsylvania have a regular source of care. However, about one-in-ten adults do not have access to a regular health care provider and, thus, may be missing out on important preventative and other health care services. The 2006 Household Health Survey data also identify racial/ethnic and socioeconomic disparities in access to routine care and highlight barriers to care such as cost, transportation, and lack of insurance that may be associated with these disparities.

For more information on these findings or the Community Health Database, contact Natalie Smith, nsmith@phmc.org, or Allegra Gordon, agordon@phmc.org.

References:
Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2006. Available at:  http://www.ahrq.gov/qual/nhdr06/nhdr06.htm

Agency for Healthcare Research and Quality, National Healthcare Quality Report, 2006. Available at: http://www.ahrq.gov/qual/nhqr06/nhqr06.htm