Access to Care: Facilitators and Barriers to Health Care

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Health Insurance
People under age 65 with health insurance
People under age 65 with public health insurance only
People under age 65 with any private health insurance
Adults age 65 and over with any private health insurance
People under age 65 who were uninsured all year
People under age 65 with any period of uninsurance during the year
People under age 65 with any period of public insurance during the year

Financial Burden of Health Care Cost
People under age 65 whose family's health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income
People under age 65 with private insurance whose family's out-of-pocket medical expenditures were more than 10% of total family income

Usual Source of Care
People without a usual source of care who indicated a financial or insurance reason for not having a source of care
People with a specific source of ongoing care
People with a usual primary care provider
People who identified a hospital, emergency room, or clinic as a source of ongoing care
People in fair or poor health with a specific source of ongoing care

Patient Perceptions of Need
People unable to get or delayed in getting needed medical care, dental care, or prescription medicines due to financial or insurance reasons
Composite measure: People who were unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last 12 months
People who were unable to get or delayed in getting needed medical care in the last 12 months
People who were unable to get or delayed in getting needed dental care in the last 12 months
People who were unable to get or delayed in getting needed prescription medicines in the last 12 months
People with a usual source of care, excluding hospital emergency rooms, who has office hours nights or weekends
People with difficulty contacting their usual source of care over the telephone
Adults who did not have problems seeing a specialist they needed to see in the last 12 months
Children who did not have problems seeing a specialist they needed to see in the last 12 months
 


Health Insurance

Measure Title

People under age 65 with health insurance.

Measure Source

Healthy People 2010.

Tables

16_1_1.1 People under age 65 with health insurance, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

Number of people under age 65 who reported coverage by any type of public or private health insurance.

Comments

This measure is referred to as measure 1-1 in Healthy People 2010 documentation.

Top of Page


Health Insurance

Measure Title

People under age 65 with public health insurance only.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

16_1_2.1 People under age 65 with public health insurance only, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

CDC, NCHS, National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

Number of people under age 65 who reported coverage by public health insurance only.

Top of Page


Health Insurance

Measure Title

People under age 65 with any private health insurance.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

16_1_3.1 People under age 65 with any private health insurance, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

CDC, NCHS, National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

Number of people under age 65 who reported coverage by private health insurance only.

Top of Page


Health Insurance

Measure Title

Adults age 65 and over with any private health insurance.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

16_1_4.1 Adults age 65 and over with any private health insurance, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

CDC, NCHS, National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population age 65 and over.

Numerator

Number of people age 65 and over who reported coverage by any private health insurance.

Top of Page


Health Insurance

Measure Title

People under age 65 who were uninsured all year.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_1_5.1 People under age 65 who were uninsured all year, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

U.S. civilian noninstitutionalized population under age 65 who reported no private or public health insurance coverage at any time during the year.

Top of Page


Health Insurance

Measure Title

People under age 65 with any period of uninsurance during the year.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_1_6.1 People under age 65 with any period of uninsurance during the year, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

U.S. civilian noninstitutionalized population under age 65 who reported they had no public or private health insurance coverage sometime during the year.

Top of Page


Health Insurance

Measure Title

People under age 65 with any period of public insurance during the year.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_1_7.1 People under age 65 with any period of public insurance during the year, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population under age 65.

Numerator

U.S. civilian noninstitutionalized population under age 65 who reported they had public health insurance coverage some time during the past year.

Comments

Public insurance includes Medicare, Medicaid, and other public programs that provide hospital/physician coverage.

Top of Page


Financial Burden of Health Care Cost

Measure Title

People under age 65 whose family's health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_2_1.1 People under age 65 whose family's health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population, ages 0-64.

Numerator

Subset of denominator whose family's out-of-pocket medical expenditures were more than 10% of total family income.

Comments

Health insurance premium is the sum of insurance premiums (imputed) and Medicare Part B.

Total family income is the sum of person-level pretax total income, refund income, and sale income. “Family” is defined in terms of health insurance eligibility units (HIEUs), which are composed of individuals who could be covered as a family under most private health insurance plans.

Health insurance was defined hierarchically for the categories below:

  • Private, employer-sponsored: People who had least one month of employer-sponsored insurance and zero month uninsured during year.
  • Private, nongroup: People who had least one month of nongroup private insurance and zero month uninsured during year.
  • Public only: People who had public insurance only for all available months in MEPS.
  • Part-year uninsured: People whose number of uninsured months is less than numbers of available months in MEPS.
  • Full-year uninsured: People whose number of uninsured months is equal to numbers of available months in MEPS.

Top of Page


Financial Burden of Health Care Cost

Measure Title

People under age 65 with private insurance whose family's out-of-pocket medical expenditures were more than 10% of total family income.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_2_2.1 People under age 65 whose private insurance whose family's out-of-pocket medical expenditures were more than 10% of total family income, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population ages 0-64 who had private insurance, including employer-sponsored and nongroup.

Numerator

Subset of denominator whose family's out-of-pocket medical expenditures were more than 10% of total family income.

Comments

Total family income is the sum of person-level pretax total income, refund income, and sale income. “Family” is defined in terms of health insurance eligibility units (HIEUs), which are composed of individuals who could be covered as a family under most private health insurance plans.

Private health insurance includes:

  • Private, employer-sponsored: People who had least one month of employer-sponsored insurance and zero month uninsured during year.
  • Private, nongroup: People who had least one month of nongroup private insurance and zero month uninsured during year.

Top of Page


Usual Source of Care

Measure Title

People without a usual source of care who indicated a financial or insurance reason for not having a source of care.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_3_1.1 People without a usual source of care who indicate a financial or insurance reason for not having a source of care, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population who reported having no usual source of care.

Numerator

U.S. civilian noninstitutionalized population who indicated financial or insurance reasons for not having a usual source of care.

Top of Page


Usual Source of Care

Measure Title

People with a specific source of ongoing care.

Measure Source

Healthy People 2010.

Tables

16_3_2.1 People with a specific source of ongoing care, United States, 1999 and 2007.

16_3_2.2 People with a specific source of ongoing care, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population.

Numerator

Number of people who reported having a specific source of primary care.

Comments

A specific source of primary care includes urgent care/walk-in clinic, doctor's office, clinic, health center facility, hospital outpatient clinic, HMO/PPO, military or other Veterans Affairs health care, or some other place. A hospital emergency room is not included as a specific source of primary care.

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

This measure is referred to as measure 1-4 in Healthy People 2010 documentation.

Top of Page


Usual Source of Care

Measure Title

People with a usual primary care provider.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_3_3.1 People with a usual primary care provider, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. population (civilian noninstitutionalized).

Numerator

U.S. civilian noninstitutionalized population who were determined to have a usual primary care provider.

Comments

A person is determined to have had a primary care provider if his or her usual source of care's setting was either a physician's office or a hospital (setting other than an emergency room), and they reported going to this usual source of care for new health problems, preventive health services, and physician referrals.

Top of Page


Usual Source of Care

Measure Title

People who identified a hospital, emergency room, or clinic as a source of ongoing care.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

16_3_4.1 People who identified a hospital, emergency room, or clinic as a source of ongoing care, United States, 1999 and 2007.

16_3_4.2 People who identified a hospital, emergency room, or clinic as a source of ongoing care, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

CDC, NCHS, National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population.

Numerator

Number of people who reported a hospital, emergency room, or clinic as a source of primary care.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

Top of Page


Usual Source of Care

Measure Title

People in fair or poor health with a specific source of ongoing care.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

16_3_5.1 People in fair or poor health with a specific source of ongoing care, United States, 1999 and 2007.

16_3_5.2 People in fair or poor health with a specific source of ongoing care, United States, 2007, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

CDC, NCHS, National Health Interview Survey (NHIS).

Denominator

Number of people who reported fair or poor health.

Numerator

Number of people who reported fair or poor health and having a specific source of primary care.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

A specific source of primary care includes urgent care/walk-in clinic, doctor's office, clinic, health center facility, hospital outpatient clinic, HMO/PPO, military or other Veterans Affairs health care, or some other place. A hospital emergency room is not included as a specific source of primary care.

Top of Page


Patient Perceptions of Need

Measure Title

People unable to get or delayed in getting needed medical care, dental care, or prescription medicines due to financial or insurance reasons.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_3_6.1 People unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last 12 months due to financial or insurance reasons, United States, 2006, by:

  1. Race
  2. Ethnicity
  3. Family income
  4. Education �

16_3_6.2 People unable to get or delayed in getting needed medical care due to financial or insurance reasons, United States, 2006, by:

  1. Race
  2. Ethnicity
  3. Family income
  4. Education

16_3_6.3 People unable to get or delayed in getting needed dental care due to financial or insurance reasons, United States, 2006, by:

  1. Race
  2. Ethnicity
  3. Family income
  4. Education

16_3_6.4 People unable to get or delayed in getting needed prescription medicines due to financial or insurance reasons, United States, 2006, by:

  1. Race
  2. Ethnicity
  3. Family income
  4. Education�

Data Source

AHRQ, CFACT, MEPS.

Denominator

Number of U.S. families who reported having at least one member experience difficulties or delays in obtaining health care.

Numerator

Number of U.S. families who reported having at least one member experience difficulties or delays in obtaining health care because they (1) could not afford it, (2) their insurance company would not approve/cover/pay for it, (3) their insurance company required a referral they could not get, (4) the doctor refused the family's insurance plan, or (5) it was too expensive to get to the site for care.

Comments

A change in survey question format in 2002 affected the way responses were collected for this item; these rates should not be compared with data from 2001 and earlier.

Race, ethnicity, family income, and education characteristics are those of the family reference person and are used to characterize the entire family unit.

Top of Page


Patient Perceptions of Need

Measure Title

Composite measure: People who were unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last 12 months.

Measure Source

Healthy People 2010.

Tables

16_4_1.1 People unable to get or delayed in getting needed medical care, dental care, or prescription medicines, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Denominator

U. S. families reporting that at least one family member experienced difficulty in obtaining health care, including those with members who attempted but did not receive care or delayed the needed care.

Numerator

Subset of the denominator of families with each of the 3 major reasons: could not afford, insurance-related reasons, and other reasons.

Comments

Reasons were grouped based on specific survey responses. The demographic data are based on information for the family reference person.

This measure is referred to as measure 1-6 in Healthy People 2010 documentation.

A change in survey question format in 2002 affected the way responses were collected for this item; these rates should not be compared with data from 2001 and earlier.

Race, ethnicity, family income, and education characteristics are those of the family reference person and are used to characterize the entire family unit.

Top of Page


Patient Perceptions of Need

Measure Title

People who were unable to get or delayed in getting needed medical care in the last 12 months.

Measure Source

Healthy People 2010.

Tables

16_4_2.1 People unable to get or delayed in getting needed medical care, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Denominator

U.S. civilian noninstitutionalized population.

Numerator

People who attempted to obtain but did not receive care or delayed needed medical care.

Top of Page


Patient Perceptions of Need

Measure Title

People who were unable to get or delayed in getting needed dental care in the last 12 months.

Measure Source

Healthy People 2010.

Tables

16_4_3.1 People unable to get or delayed in getting needed dental care, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Denominator

U.S. civilian noninstitutionalized population.

Numerator

People who attempted to obtain but did not receive care or delayed needed dental care.

Top of Page


Patient Perceptions of Need

Measure Title

People who were unable to get or delayed in getting needed prescription medicines in the last 12 months.

Measure Source

Healthy People 2010.

Tables

16_4_4.1 People unable to get or delayed in getting needed prescription medicines, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Denominator

U.S. civilian noninstitutionalized population.

Numerator

People who attempted to obtain but did not receive medications or delayed the needed prescription medicines.

Top of Page


Patient Perceptions of Need

Measure Title

People with a usual source of care, excluding hospital emergency rooms, who has office hours nights or weekends.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_4_5.1 People with a usual source of care, excluding hospital emergency rooms, who has office hours nights or weekends, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population who reported having a usual source of care.

Numerator

U.S. civilian noninstitutionalized population who reported having a usual source of care who subsequently reported that they have a provider who has office hours nights or weekends.

Top of Page


Patient Perceptions of Need

Measure Title

People with difficulty contacting their usual source of care over the telephone.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_4_6.1 People with difficulty contacting their usual source of care over the telephone, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population who report having a usual source of care.

Numerator

U.S. civilian noninstitutionalized population who report having a usual source of care who subsequently reported that they have difficulty contacting their provider over the telephone.

Top of Page


Patient Perceptions of Need

Measure Title

Adults who did not have problems seeing a specialist they needed to see in the last 12 months.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_4_7.1 Adults who did not have problems seeing a specialist they needed to see in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized adults age 18 and over who reported that, during the previous 12 months, they or a doctor thought they needed to see a specialist.

Numerator

U.S. civilian noninstitutionalized adults age 18 and over who reported that, during the previous 12 months, they or a doctor thought they needed to see a specialist and who subsequently reported no problems getting a referral to a specialist in the past year.

Comments

Tables report data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources appendix for more information on the SAQ.

Top of Page


Patient Perceptions of Need

Measure Title

Children who did not have problems seeing a specialist they needed to see in the last 12 months.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

16_4_8.1 Children who did not have problems seeing a specialist they needed to see in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized children under age 18 whose parents reported that, during the previous 12 months, they or a doctor thought they needed to see a specialist.

Numerator

U.S. civilian noninstitutionalized children under age 18 whose parents reported that, during the previous 12 months, they or a doctor thought they needed to see a specialist and who subsequently reported no problems getting a referral to a specialist in the past year.

Comments

Tables report data from the MEPS Child Health and Preventive Care section. See the MEPS entry in the Data Sources appendix for more information on this component of MEPS.

 

Current as of March 2010
Internet Citation: Access to Care: Facilitators and Barriers to Health Care: 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/measurespec/facilitators_and_barriers_to_health_care.html