| Table
3.2 Overview of the Robert Wood Johnson Foundation National Access-to-Care
Surveys: 1976, 1982, 1986, and 1994. |
| |
| Year |
Institution |
Sample
Size |
Interview
Mode |
Oversampled
Groups |
Selected Major Findings |
Design Issues |
| |
| 1976 |
Center for Health
Administration
Studies, University of Chicago |
7,787 |
In person |
- Individuals with episodes of illness
- Non-SMSA Southern blacks
- Hispanics in the Southwestern
United States
|
- Percent with usual source of care (USOC) up for
elderly and poor; uninsured remain most likely to have no USOC.
- Access worse (e.g., longer travel times and lower
rates of insurance coverage) among farm dwellers, residents of the South—particularly
non-urban Southern blacks—and Hispanics in Southwest.
- Hospital and physician services obtained according
to illness levels. Dental care more dependent on social structural variables and family
resources and less on need.
- People generally satisfied with care; highest
levels of dissatisfaction
with out-of-pocket medical care costs and waiting times in clinics and physician offices.
|
|
| |
|
|
|
|
|
|
| 1982 |
Center for Health
Administration
Studies, University of Chicago |
6,610 |
Telephone |
- Individuals with family incomes below 150% of
poverty
|
- Poor, minorities, central city, and farm residents
mostly maintained or improved with respect to having a USOC or using hospital, physician,
and preventive services.
- Access problems continue for disadvantaged groups
with respect to site of USOC, waiting times for care, and levels of satisfaction with
care. Uninsured most consistently disadvantaged in terms of access indicators.
- Even after adjustment for need and other factors,
the uninsured and those without a USOC have lower rates of hospitalization and lower rates
of use of adult preventive services.
- Of families with a seriously or chronically
ill family member, 22% reported a major financial problem as a result. Most likely to
report major financial problems were the uninsured (52%), poor
nonwhites (50%), blacks (40%),
Hispanics (39%), and people with public insurance only (36%).
|
- Potential undercount of uninsured and other
vulnerable populations due to reliance on telephone
interviews.
|
| |
|
|
|
|
|
|
| 1986 |
Institute for Social
Sciences Research, University of
California,
Los Angeles |
10,130 |
Telephone |
- Individuals with chronic and serious illnesses
|
- Overall use of medical care (in terms of hospital
admissions and physician visits) declined.
- Access to physician care for individuals who were
poor, black, or uninsured decreased between 1982 and 1986, particularly fort hose in poor
health.
- Disadvantaged groups (including blacks, Hispanics,
and the uninsured) continue to receive less hospital care than might be appropriate given
their higher rate of ill health.
- The long-standing gap in receipt of medical care
between rural and urban residents appears to have been eliminated.
- Most Americans continue to be highly satisfied
with their physician and inpatient hospital care.
|
- Sole reliance on telephone interviewing led to
undercount of uninsured.
- Small number of persons denied care resulted in
cell size too small for much analysis.
|
| 1994 |
Project HOPE Center
for Health Affairs |
7,562 |
Mixed mode:
telephone,with in-person substantially but interviews for eliminated due to persons with
no phones or hearing impaired |
- Individuals with poor access or specific health
conditions, as identified through an existing national probability survey
|
- Proportion of persons reporting
inability to obtain needed medical/surgical care has remained relatively
constance since 1982, at about 6% of the population.
- Using more inclusive definition
of health care needs (including medical/surgical care, dental care,
prescription drugs, eyeglasses, and mental health care), 16.1%
of respondents (more than 41 million Americans) were unable to obtain
at least one service they believed they needed.
- For each service, Medicaid enrollees
were half as likely to report problems as uninsured and twice as likely
as privately insured.
- HMO enrollees had more physician
visits than persons in tradional plans but are more likely to report
unmet medical need.
|
- Undercount of uninsured reduced substantially but
not eliminated due to coninued reliance on telephone for most interviews
|