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June 22, 1994, Vol 271, No. 24 >
ARTICLE | June 22, 1994

Obstacles Predicting Lack of a Regular Provider and Delays in Seeking Care for Patients at an Urban Public Hospital FREE

Kimberly J. Rask, MD, PhD; Mark V. Williams, MD; Ruth M. Parker, MD; Sally E. McNagny, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Medicine, Emory University School of Medicine, 69 Butler St SE, Glenn Memorial Building, Atlanta, GA 30303 (Dr Rask).


JAMA. 1994;271(24):1931-1933. doi:10.1001/jama.1994.03510480055034
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References

Objective.  —To determine the correlation among obstacles to medical care, lack of a regular source of care, and delays in seeking care.

Design.  —Cross-sectional survey of patients presenting for ambulatory care during a 7-day period. Multiple logistic regression models were used to identify obstacles independently associated with outcome variables.

Setting.  —Urban public hospital.

Patients.  —A total of 3897 disadvantaged and predominantly minority patients.

Main Outcome Measures.  —Lack of a regular source of medical care and delay in seeking medical care for a new problem.

Results.  —The majority (61.6%) of patients reported no regular source of care. Of 2341 patients reporting a new medical problem, 48.4% waited more than 2 days before seeking medical care. No health insurance (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.89 to 2.61), no transportation (OR, 1.44; 95% CI, 1.23 to 1.70), exposure to violence (OR, 1.21; 95% CI, 1.08 to 1.45), and living in a supervised setting (OR, 1.50; 95% CI, 1.00 to 2.25) were independent predictors of lack of a regular source of care. No insurance (OR, 1.24; 95% CI, 1.02 to 1.51), no transportation (OR, 1.45; 95% CI, 1.19 to 1.77), and less than a high school education (OR, 1.22; 95% CI, 1.08 to 1.49) were independent predictors of delaying care for a new medical problem.

Conclusions.  —Obstacles in addition to lack of insurance impede provision of medical care to disadvantaged patients. The adoption of universal health care coverage alone will not guarantee access to appropriate medical care.(JAMA. 1994;271:1931-1933)

REFERENCES

1 +
Adler NE, Boyce WT, Chesney MA, Folkman S, Syme L.  Socioeconomic inequalities in health: no easy solution. JAMA . 1993;;269:3140-3145.
2 +
Epstein AM, Stern RS, Tognelti J, et al.  The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups. N Engl J Med . 1988;;318:1579-1585.
3 +
Dutton DB, Levine S.  Overview, methodologic critique, and reformulation.  In: Bunker JP, Comby DS, Kehrer BH, eds. Pathways to Health . Menlow Park, Calif: Henry J Kaiser Family Foundation; 1989;:29-69.
4 +
Feinstein JS.  The relationship between socioeconomic status and health: a review of the literature. Milbank Q . 1993;;71:279-322.
5 +
Dutton DB.  Explaining the low use of health services by the poor: costs, attitudes or delivery systems. Am Soc Rev . 1978;;43:348-368.
6 +
Pappas G, Queen S, Hadden W, Fisher G.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med . 1993;;329:103-109.
7 +
Riportella-Muller R, Richardson LA, Luchok K, Donat P, Selby-Harrington M. Non-financial barriers to preventive care use: the case of EPSDT. Read before the Association of Health Services Research Annual Meeting, June 29,1993; Washington, DC.
8 +
St Peter R, Newacheck P, Halfon N.  Access to care for poor children: separate and unequal. JAMA . 1992;;267:2760-2764.
9 +
Savitz L, Ricketts T. Maternal employment as a potential barrier to obstetrical care access. Presented as a poster at the Association of Health Services Research Annual Meeting; June 29,1993; Washington, DC.
10 +
Kiefe CI, Harrison PL.  Post-hospitalization follow-up appointment-keeping among the medically indigent. J Community Health . 1993;;18:271-282.
11 +
Kindig DA, Movassaghi H, Dunham NC, Zwick DI, Taylor CM.  Trends in physician availability in 10 urban areas from 1963 to 1980. Inquiry . 1987;; 24:136-146.
12 +
Yudkowsky BK, Cartland JD, Flint SS.  Pediatrician participation in Medicaid: 1978-1989. Pediatrics . 1990;;85:567-577.
13 +
Weissman JS, Stern R, Fielding SL, Epstein AM.  Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med . 1991;; 114:325-331.
14 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;;327:776-781.
15 +
Wenneker MB, Epstein AM.  Racial inequalities in the use of cardiac procedures for patients with ischemic heart disease in Massachusetts. JAMA . 1989;;261:253-257.
16 +
Weissman J, Epstein AM.  Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area. JAMA . 1989;;261:3572-3576.
17 +
Yelin EH, Kramer JS, Epstein W.  Is health care use equivalent across social groups? a diagnosisbased study. Am J Public Health . 1983;;73:563-571.
18 +
Hayward RA, Bernard AM, Freeman HE, Corey CR.  Regular source of ambulatory care and access to health services. Am J Public Health . 1990;; 81:434-438.
19 +
Piper JM, Ray WA, Griffen MR.  Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA . 1990;;264: 2219-2223.
20 +
Miller CL, Margolis LH, Schwethelm B, Smith S.  Barriers to implementation of a prenatal program for low income women. Am J Public Health . 1989;;79:62-64.
21 +
Smith GD, Bartley M, Bleane D.  The Black Report on socioeconomic inequalities in health 10 years on. BMJ . 1990;;301:373-377.
22 +
Lahelma E, Valkonen T.  Health and social inequalities in Finland and elsewhere. Soc Sci Med . 1990;;31:257-265.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Adler NE, Boyce WT, Chesney MA, Folkman S, Syme L.  Socioeconomic inequalities in health: no easy solution. JAMA . 1993;;269:3140-3145.
2 +
Epstein AM, Stern RS, Tognelti J, et al.  The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups. N Engl J Med . 1988;;318:1579-1585.
3 +
Dutton DB, Levine S.  Overview, methodologic critique, and reformulation.  In: Bunker JP, Comby DS, Kehrer BH, eds. Pathways to Health . Menlow Park, Calif: Henry J Kaiser Family Foundation; 1989;:29-69.
4 +
Feinstein JS.  The relationship between socioeconomic status and health: a review of the literature. Milbank Q . 1993;;71:279-322.
5 +
Dutton DB.  Explaining the low use of health services by the poor: costs, attitudes or delivery systems. Am Soc Rev . 1978;;43:348-368.
6 +
Pappas G, Queen S, Hadden W, Fisher G.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med . 1993;;329:103-109.
7 +
Riportella-Muller R, Richardson LA, Luchok K, Donat P, Selby-Harrington M. Non-financial barriers to preventive care use: the case of EPSDT. Read before the Association of Health Services Research Annual Meeting, June 29,1993; Washington, DC.
8 +
St Peter R, Newacheck P, Halfon N.  Access to care for poor children: separate and unequal. JAMA . 1992;;267:2760-2764.
9 +
Savitz L, Ricketts T. Maternal employment as a potential barrier to obstetrical care access. Presented as a poster at the Association of Health Services Research Annual Meeting; June 29,1993; Washington, DC.
10 +
Kiefe CI, Harrison PL.  Post-hospitalization follow-up appointment-keeping among the medically indigent. J Community Health . 1993;;18:271-282.
11 +
Kindig DA, Movassaghi H, Dunham NC, Zwick DI, Taylor CM.  Trends in physician availability in 10 urban areas from 1963 to 1980. Inquiry . 1987;; 24:136-146.
12 +
Yudkowsky BK, Cartland JD, Flint SS.  Pediatrician participation in Medicaid: 1978-1989. Pediatrics . 1990;;85:567-577.
13 +
Weissman JS, Stern R, Fielding SL, Epstein AM.  Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med . 1991;; 114:325-331.
14 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;;327:776-781.
15 +
Wenneker MB, Epstein AM.  Racial inequalities in the use of cardiac procedures for patients with ischemic heart disease in Massachusetts. JAMA . 1989;;261:253-257.
16 +
Weissman J, Epstein AM.  Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area. JAMA . 1989;;261:3572-3576.
17 +
Yelin EH, Kramer JS, Epstein W.  Is health care use equivalent across social groups? a diagnosisbased study. Am J Public Health . 1983;;73:563-571.
18 +
Hayward RA, Bernard AM, Freeman HE, Corey CR.  Regular source of ambulatory care and access to health services. Am J Public Health . 1990;; 81:434-438.
19 +
Piper JM, Ray WA, Griffen MR.  Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA . 1990;;264: 2219-2223.
20 +
Miller CL, Margolis LH, Schwethelm B, Smith S.  Barriers to implementation of a prenatal program for low income women. Am J Public Health . 1989;;79:62-64.
21 +
Smith GD, Bartley M, Bleane D.  The Black Report on socioeconomic inequalities in health 10 years on. BMJ . 1990;;301:373-377.
22 +
Lahelma E, Valkonen T.  Health and social inequalities in Finland and elsewhere. Soc Sci Med . 1990;;31:257-265.

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