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Care denied: US residents who are unable to obtain needed medical services

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  • Himmelstein, D.U.
  • Woolhandler, S.

Abstract

Objectives. This study analyzed data on US residents reporting that they were unable to obtain needed care. Inadequately immunized children and women inadequately screened for breast or cervical cancer were also examined. Methods. Data from the 1987 National Medical Expenditure Survey was analyzed. Results. A total of 6 375 000 (90% confidence interval [CI] = 6 039 000, 6 711 000) people could not get hospitalization, prescription medications, medical equipment/supplies, or emergency, pediatric, mental health, or home care. Although the uninsured were more likely to forego care unavailable, three quartets of those unable to obtain services were insured, and 46% (90% CI = 42.4%, 49.6%) had private coverage. Of those reporting the reason why they failed to obtain care, 65.1% (90% CI = 61.7%, 68.6%) listed high costs or lack of insurance, including 60.7% (90% CI = 57.1%, 64.3%) of the privately insured. More than a third of women had not had a breast examination in the previous 2 years, a fifth had not had a Pap smear within the previous 4 years, and half had never had a mammogram (ages 50-69 only). Of children 2 to 5 years old, 35.1% (90% CI = 31.5%, 35.7%) were inadequately immunized. Medicaid recipients had measures of access to care similar to those of the uninsured. Conclusions. Many US residents-most of whom have insurance-are unable to obtain needed care, usually because of high costs.

Suggested Citation

  • Himmelstein, D.U. & Woolhandler, S., 1995. "Care denied: US residents who are unable to obtain needed medical services," American Journal of Public Health, American Public Health Association, vol. 85(3), pages 341-344.
    • Handle: RePEc:aph:ajpbhl:1995:85:3:341-344_9
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    Cited by:

    1. Allin, Sara & Grignon, Michel & Le Grand, Julian, 2010. "Subjective unmet need and utilization of health care services in Canada: What are the equity implications?," Social Science & Medicine, Elsevier, vol. 70(3), pages 465-472, February.
    2. Malat, Jennifer R. & van Ryn, Michelle & Purcell, David, 2006. "Race, socioeconomic status, and the perceived importance of positive self-presentation in health care," Social Science & Medicine, Elsevier, vol. 62(10), pages 2479-2488, May.
    3. Jatrana, Santosh & Crampton, Peter, 2009. "Primary health care in New Zealand: Who has access?," Health Policy, Elsevier, vol. 93(1), pages 1-10, November.
    4. Erik Schokkaert & Jonas Steel & Carine Van de Voorde, 2017. "Out-of-Pocket Payments and Subjective Unmet Need of Healthcare," Applied Health Economics and Health Policy, Springer, vol. 15(5), pages 545-555, October.
    5. Jatrana, Santosh & Crampton, Peter, 2021. "Do financial barriers to access to primary health care increase the risk of poor health? Longitudinal evidence from New Zealand," Social Science & Medicine, Elsevier, vol. 288(C).
    6. Jens Detollenaere & Lise Hanssens & Veerle Vyncke & Jan De Maeseneer & Sara Willems, 2017. "Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-13, January.
    7. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
    8. Gibson, Grant & Clair, Luc, 2019. "O brother how art thou: Propensity to report self-assessed unmet need," Social Science & Medicine, Elsevier, vol. 243(C).
    9. Grant Gibson & Michel Grignon & Jeremiah Hurley & Li Wang, 2019. "Here comes the SUN: Self‐assessed unmet need, worsening health outcomes, and health care inequity," Health Economics, John Wiley & Sons, Ltd., vol. 28(6), pages 727-735, June.

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