National Healthcare Disparities Report 2004

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 care services a struggle. As demonstrated by extensive research and confirmed in the first National Healthcare Disparities Report (NHDR), racial and ethnic minorities and people of low socioeconomic status (SES) are disproportionately represented among those with access problems.

Components of Health Care Access

Access to health care means having "the timely use of personal health services to achieve the best health outcomes¹." Attaining good access to care requires three discrete steps:

Getting into the health care system - People need to gain entry into the system in order to receive needed care.
Getting care within the health care system - Once in the system, people need to go to sites of care where they can receive the specific services they need.
Finding providers who meet individual patient needs - Once they identify appropriate sites of care, people need to find specific providers with whom they can develop a relationship based on mutual communication and trust².

Health care access is measured in several ways including:

Structural measures - Measures of the presence or absence of specific resources that enable health care, such as having health insurance or having a provider with hours on nights or weekends.
Patient assessments - Measures of patients' perceptions of how well their providers interact with them.
Health care utilization - Measures of the ultimate outcome of good access to care; i.e., the successful receipt of needed services.

How This Chapter Is Organized

This chapter presents new information about disparities in access to health care in America. It is divided into four sections:

Getting into the health care system
Getting care within the health care system
Patient perceptions of care
Health care utilization

As in the 2003 NHDR, 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 found in Chapter 4, Priority Populations. In addition to presenting new data, this chapter goes beyond last year's report and adds analyses of changes over time as well as some multivariate models and stratified analyses. To present this greater detail, the sections of the chapter highlight a small number of measures, where applicable. Results for all measures are found in the summary tables at the end of the chapter.

The first NHDR included measures of cultural competency and health information. This year, new data on these topics are not available, so they are not discussed. New data on these topics are anticipated next year.