Demographic Characteristics of Persons Without a Regular Source of Medical Care -- Selected States, 1995

Having a regular source of medical care (i.e., a regular provider or site) is one of the strongest predictors of access to health-care services (1,2), which has been associated with greater use of preventive health services (3,4). This report summarizes state-specific data from the 1995 Behavioral Risk Factor Surveillance System (BRFSS) and examines demographic factors associated with not having a regular source of medical care among adults in the 10 states for which this information was available. The findings indicate that certain demographic characteristics are associated with lack of a regular source of medical care.

The BRFSS is a state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged greater than or equal to 18 years (5). The 1995 BRFSS collected information about source of medical care from 15,989 survey respondents in 10 states (Alaska, Arizona, Illinois, Kansas, Louisiana, Mississippi, New Jersey, North Carolina, Oklahoma, and Virginia). Participants were asked, "Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?" Prevalence estimates were calculated for persons who reported not having a regular source of medical care, and the reasons given for not having a regular source of medical care were examined. Sample estimates were weighted to represent the civilian population of each state, and SUDAAN{Registered} (Software for the Statistical Analysis of Correlated Data) was used to calculate 95% confidence intervals (6). Response rates ranged from 61.6% in Illinois to 76.2% in Oklahoma (7) (overall response rate: 68.4%).

State-specific estimates of persons who lacked a regular source of medical care ranged from 11.0% in Oklahoma to 20.4% in Arizona (median: 14.4%) (Table_1). Among men, the prevalence of not having a regular source of medical care ranged from 13.5% in Oklahoma and New Jersey to 25.1% in Alaska (median: 20.3%). Among women, the prevalence of not having a regular source of medical care was lower and ranged from 8.5% in Illinois and North Carolina to 16.2% in Arizona (median: 9.5%). In most states, both white and black adults were more likely than Hispanics to have a regular source of medical care.

In all states, as age increased, the likelihood of having a regular source of medical care also increased. The prevalence of not having a regular source of medical care was highest among persons aged 18-29 years (range: 16.6%-31.4%; median: 25.5%), and lowest among persons aged greater than or equal to 65 years (range: 2.0%-10.2%; median: 4.1%). In all states except North Carolina, persons with annual household incomes less than $15,000 were more likely to not have a regular source of medical care than those with incomes greater than or equal to $50,000.

Persons without health-care insurance were more likely to not have a regular source of care than those who did have health-care coverage (Table_2). Among persons who were uninsured, the prevalence of not having a regular source of medical care ranged from 24.7% in Louisiana to 55.4% in Arizona (median: 34.7%); and for those who were insured, from 6.6% in Oklahoma to 14.8% in Virginia (median: 12.0%).

When persons who did not have a regular source of health care were asked why, most (43.2%) reported that they did not need a doctor (range: 38.5% in New Jersey to 55.2% in Mississippi). More than 18% reported that they either had no health-care insurance or could not afford to visit a doctor.

Reported by the following BRFSS coordinators: P Owen, Alaska; B Bender, Arizona; B Steiner, MS, Illinois; M Perry, Kansas; R Meriwether, MD, Louisiana; P Arbuthnot, Mississippi; G Boeselager, MS, New Jersey; K Passaro, PhD, North Carolina; N Hann, MPH, Oklahoma; L Redman, Virginia. S Bland, MS, TRW Inc., Atlanta, Georgia. Behavioral Surveillance Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that persons without a regular source of medical care are more likely to be young, male, Hispanic, and uninsured and to have a low household income. Most persons who did not have a regular source of medical care did not think they needed a regular source. The results suggest the need for education about the health benefits of having a primary source of medical care, including early identification of health problems and increased access to and use of preventive health services. In addition, the results provided information about factors, such as lack of health-care coverage and cost considerations, that might prevent access to preventive care and other appropriate health services.

The findings in this report are subject to at least two limitations. First, because households without telephones were not surveyed, the findings might underrepresent persons who have less education, have a lower annual household income, or are unemployed -- all of which have been associated with increased likelihood of not having a regular source of health care (8). Second, because the estimates were based on self-reported data, they may be subject to recall bias.

Having a regular source of medical care is one of the strongest predictors of access to health services (2). Persons who lack a regular source for medical care have less access to primary care (2) and are more likely to experience a delay in seeking preventive health care and services (4); such persons, therefore, are at greater risk for chronic health conditions. Identification of subgroups at increased risk (i.e., young adults, males, Hispanics, persons with low incomes, and uninsured persons) is important in targeting prevention strategies to ensure greater access to and use of preventive health services. These results suggest that a policy of promoting a regular source of medical care is likely to facilitate access to health-care services for adults. At the state level, information about regular source of medical care can be used to develop policies promoting better access to health-care services, thereby lowering the prevalence of chronic health problems and associated economic costs.

References

1. Andersen R, Aday LA. Access to medical care in the U.S.: realized and potential. Med Care 1978;16:533.

2. Bindman AB, Grumbach K, Osmond D, Vranizan K, Stewart AL. Primary care and receipt of preventive services. J Gen Intern Med 1996;11:269-76.

3. CDC. Health insurance coverage and receipt of preventive health services -- Behavioral Risk Factor Surveillance System, 1993. MMWR 1995;44:219-25.

4. Lambrew JM, DeFriese GH, Carey TS, Ricketts TC, Biddle AK. The effects of having a regular doctor on access to primary care. Med Care 1996;34:138-51.

5. CDC. State- and sex-specific prevalence of selected characteristics -- Behavioral Risk Factor Surveillance System, 1992 and 1993. In: CDC surveillance summaries (December). MMWR 1996; 45(no. SS-6).

6. Shah BV, Barnwell BG, Bieler GS. SUDAAN user's manual, version 6.4. 2nd ed. Research Triangle Park, North Carolina: Research Triangle Institute, 1996.

7. White AA. Response rate calculation in RDD telephone health surveys: current practices. In: Proceeding of the American Statistical Association, Section on Survey Research Methods. Washington, DC: American Statistical Association, 1983:277-82.

8. Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med 1991;114:325-31.

TABLE 1. Percentage of persons without a regular source of medical care, by state and
sex -- selected states, Behavioral Risk Factor Surveillance System, 1995
=========================================================================================
                           Men                    Women                   Total
                  ---------------------   ---------------------   ---------------------
State              %       (95% CI *)      %        (95% CI)       %        (95% CI)
---------------------------------------------------------------------------------------
Alaska            25.1    (20.1%-30.1%)    9.9    ( 6.9%-12.9%)   18.0    (14.9%-21.1%)
Arizona           24.7    (20.3%-29.1%)   16.2    (13.4%-19.0%)   20.4    (17.9%-22.9%)
Illinois          22.4    (18.5%-26.3%)    8.5    ( 6.3%-10.7%)   15.0    (12.7%-17.3%)
Kansas            20.7    (17.6%-23.8%)    8.8    ( 7.0%-10.6%)   14.3    (12.5%-16.1%)
Louisiana         19.1    (15.7%-22.5%)   10.4    ( 8.3%-12.5%)   14.5    (12.5%-16.5%)
Mississippi       19.9    (16.3%-23.5%)    9.0    ( 6.9%-11.1%)   14.1    (12.1%-16.1%)
New Jersey        13.5    ( 9.9%-17.1%)   10.3    ( 8.1%-12.5%)   11.9    ( 9.8%-14.0%)
North Carolina    15.5    (12.0%-19.0%)    8.5    ( 6.5%-10.5%)   11.9    ( 9.9%-13.9%)
Oklahoma          13.5    ( 9.8%-17.2%)    8.6    ( 6.6%-10.6%)   11.0    ( 9.3%-12.7%)
Virginia          21.9    (18.5%-25.3%)   13.0    (10.8%-15.2%)   17.3    (15.3%-19.3%)

Median            20.3                     9.5                    14.4
---------------------------------------------------------------------------------------
* Confidence interval.
=========================================================================================

TABLE 2. Percentage of persons without a regular source of medical care, by state and
health insurance status -- selected states, Behavioral Risk Factor Surveillance System, 1995
=========================================================================================
                         Insured                Uninsured                 Total
                  ---------------------   ---------------------   ---------------------
State              %       (95% CI *)      %        (95% CI)       %        (95% CI)
---------------------------------------------------------------------------------------
Alaska            14.1    (11.0%-17.2%)   39.5    (30.3%-48.7%)   18.0    (14.9%-21.1%)
Arizona           14.1    (11.6%-16.6%)   55.4    (47.2%-63.6%)   20.4    (17.9%-22.9%)
Illinois          12.2    (10.0%-14.4%)   38.3    (28.0%-48.6%)   15.0    (12.7%-17.3%)
Kansas            11.4    ( 9.7%-13.4%)   33.2    (25.8%-40.6%)   13.9    (12.9%-15.7%)
Louisiana         11.8    ( 9.9%-13.7%)   24.7    (19.1%-30.3%)   14.5    (12.5%-16.5%)
Mississippi       12.2    (10.2%-14.2%)   25.9    (18.6%-33.2%)   14.2    (12.2%-16.2%)
New Jersey         9.5    ( 7.2%-11.5%)   33.5    (22.7%-44.3%)   11.4    ( 9.4%-13.4%)
North Carolina     8.6    ( 6.2%-10.4%)   35.2    (26.3%-44.1%)   11.8    ( 9.8%-13.8%)
Oklahoma           6.6    ( 5.1%- 8.1%)   35.4    (28.6%-42.2%)   10.9    ( 9.2%-12.6%)
Virginia          14.8    (12.8%-16.8%)   34.1    (26.7%-41.5%)   17.1    (15.1%-19.1%)

Median            12.0                    34.7                    14.3
---------------------------------------------------------------------------------------
* Confidence interval.
=========================================================================================

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