Health insurance coverage and lack thereof largely determine access. In 2007, 44.8 million Americans were uninsured, most of them with little or no access to health care. Forty-seven percent of uninsured adults had no regular source of health care within the past year, and 38 percent had no health care visits in a 12-month period. This percentage is 3 times that of the insured population. Adults without insurance are also less likely to get preventative services, like regular mammograms or pap smears.

Costs also affect access to health care. About 6 percent of the population is unable to obtain necessary medical care because of high costs, and this percentage has been increasing over the past several years. Additionally, 8 percent of Americans delay medical care because of financial difficulties. Among the uninsured, the percentages with health care access difficulties because of costs are even higher. In one study, 47 percent of the uninsured postponed seeking care in a 12-month period because of costs, and 37 percent of them did not fill a prescription because of cost.

The barriers to health care experienced by the uninsured directly impact their health. Having health insurance reduces mortality rates by 10 to 15 percent. The uninsured have less access to preventative care and therefore are diagnosed later and die earlier from cancer. The uninsured are also less likely to receive lifesaving surgical interventions for cardiac illnesses. Because 20 percent of the uninsured use the emergency room as their usual source of care, they are also more likely to spend time in a hospital for avoidable health conditions.

Many of those who experience barriers in access because of costs delay or go without necessary health care, which can exacerbate existing health conditions. More than 4 in 10 adults report having a chronic condition, like cancer, heart disease, and diabetes. These individuals are more likely to report that they or a member of their household delayed or skipped treatment because of costs: 38 percent compared with only 22 percent of their healthier counterparts. In another study, of the 13 percent with an unmet health need, 7 percent reported it was because of cost.

Bibliography:

1) Kaiser Family Foundation. 2006. "The Uninsured and Their Access to Health Care." Washington, DC: Kaiser Family Foundation.

2) Lasser, Karen E., David U. Himmelstein, and Steffie Woolhandler. 2006. "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey." American Journal of Public Health 96(7):1300-1307.

3) U.S. Department of Health and Human Services. 2007. "Health, United States, 2007." Hyattsville, MD: U.S. Department of Health and Human Services.

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