Access to Health Care
Ability to obtain health services when needed.
Yaseen Hayajneh, RN, MPH, PhD
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Iron Triad of Health Care
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Access to Health Care
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John Q (2002)
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John Q (2002)
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John Quincy Archibald's son Michael collapses while
playing baseball as a result of a heart failure.
Immediately, John Q. rushes Michael to the hospital's
emergency room for a transplant.
Unfortunately, the insurance would not cover his son's
transplant.
So in order for Michael's quick and complete recovery,
John takes the emergency room hostage until the
hospital agrees to do the needed transplant.
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Access to Health Care: Definition
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The ability to obtain health services when
needed.
 2 Major Components of Access to HC
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Financial = Ability to pay
Non-Financial = Availability of health care
personnel and facilities that are:
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Close to where people live
Accessible by transportation
Culturally acceptable
Capable of providing appropriate care in timely manner
and in a language spoken by users.
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Financial Barriers to Health Care
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Lack of Insurance

Health insurance is a key factor in making
health care accessible.
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Number of the Uninsured in USA
Escalating Cost &
Recessionary Cycles
Economic Recession
Good Economy
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Why People Lack Insurance - USA
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Skyrocketing cost of health care
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Insurance became unaffordable to businesses and
individuals.
Destabilized Economy and Workforce
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More low-wage
Increasingly part-time
Non-unionization
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Who are the Uninsured: Race and Ethnicity
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In 2002, USA
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32% of Latinos
20% of African Americans
18% of Asian Americans
11% of non-Hispanic whites
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Who are the Uninsured: Income
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In 2002, USA
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In 2002, USA
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24% of those with < $25,000 Yearly Income
8% of those with > 75,000 Yearly Income
30% of those with incomes below FPL
People who are poor and members of minority
groups are four times as likely to be uninsured
as higher income white persons.
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Characteristics of the Uninsured, USA
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Health Insurance and Use of Services..1
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The simplest measurement of Access is the
number of times a person uses HC services.
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Physician visits
Hospital days
Preservative services received.
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Health Insurance and Use of Services..2
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The uninsured are less likely to have a regular
source of health care and more likely to report
delays in receiving health care.
 The influence of health insurance on access is
complicated by the factor of income, because
lack of insurance is correlated with low
income.

Lack of insurance rather than low income is the
main barrier to using health services.
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Percentage not Getting Care Due to Cost
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Measures of Health Outcome (Indicators)
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Avoidable Hospitalization
Mortality rates
Blood Pressure Control among hypertensive
Low birth weight
Neonatal deaths
Appendix rupture rates
…
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Health Insurance and Health Outcomes..1
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The uninsured suffer worse health outcomes
than those with insurance.
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Uninsured - appendicitis are more likely…rupture
Those who lost their Medicaid coverage have
worse control of BP than those who retained it.
Uninsured newborns have higher rates of death.
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Health Insurance and Health Outcomes..2
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Uninsured suffer a higher overall mortality rate
than those with insurance.
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Uninsured adults have higher rates of in-hospital
mortality compared with insured.
A study found that lack of insurance increased the
risk of dying by 25%.
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under-INSURANCE
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Happens when health insurance coverage has
limitations that restrict access to needed
services.
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Lack of coverage for catastrophic expenses.
Exclusion of coverage for pre-existing illnesses.
Services not covered.
Insurance deductibles and co-payments
In USA, Gaps in Medicare coverage
Lack of coverage for long term care (LTC)
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The Effects of Underinsurance
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Cost sharing reduces the rate of ambulatory
care use, especially among the poor.
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Lack of comprehensive insurance reduces
access to health care services and may
contribute to poorer health oucomes.
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Non-Financial Barriers to Health Care
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Non-financial Barriers to Health Care
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Long distance to facilities
Language
Literacy
Cultural differences
Gender
Race
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Gender & Access to Health Care
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Women are
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25% more likely than men to report not needed health care.
50% more than men to report leaving a physician because of
dissatisfaction with their care.
Over twice likely to report that their physician “talked down” to
them.
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Female physicians are more patient-centered and
spend more time with their patients than male
physicians.
 It seems that women has lower levels of access to HC
than males.
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Race and Access to Health Care
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There seems to be racial disparities in access
to health care - USA
 Explanations
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Availability of services in minorities’ communities.
Culture – Different conceptualization of issues.
Communication barriers
History of institutional racism and segregation.
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Income and Health Status
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Income level of individuals and distribution of
income within communities seems to influence
the overall health of populations.
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Access to HC and Health Status

Access to HC is one determinant of health
status.
 Other socioeconomic factors determines
health status (income, education and
occupations).
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