BACKGROUND: Access to care is often defined by insurance status and receiving medical care. Reasons why persons cannot access care are complex. In this study we define access to care comprehensively and identify populations that might benefit from changes in social services policies.
METHODS: Using 2013–2014 Utah Behavioral Risk Factor Surveillance System self-reported telephone survey data, we defined having no access to care if care was unacceptable, unavailable, or unaffordable. Using bivariate analyses and logistic regression, we assessed association of health status and demographic factors with no access to care, unacceptable care, unavailable care, and unaffordable care.
RESULTS: Approximately half of 10,435 respondents (55.2%; 95% confidence interval [CI] 54.1–56.4) lacked access to care, with 3.0% (CI 2.6–3.4) reporting care was unacceptable, 35.7% ( CI 34.5–36.8) unavailable, and 35.0% (CI 33.9–36.2) unaffordable. Among insured persons, 43.3% (CI 42.0–44.6) lacked access to care. Adults earning < $25,000 annually had increased odds of no access to care (adjusted odds ratio [aOR] = 2.5 [CI 2.0-3.1]) compared to adults earning ≥ $50,000. Those with physical, mental, or emotional limitations had increased odds of unacceptable care (aOR = 2.6 [CI 1.8–3.9]). Compared with adults ≥ 75 years, adults aged 18–39 years had the highest odds of unavailable care (aOR = 3.0 [CI 2.2–4.1]); whereas, adults aged 40–49 years had the highest odds of unaffordable care (aOR = 5.4 [CI 3.7–7.9]). There was no significant association between access and county of residence (urban, rural, or frontier).
CONCLUSIONS: The majority of adult Utahns, including some with insurance, lacked access to care. Access to care did not differ by geography. Factors associated with no access to care include specific age and income groups, which can be used to tailor public health and social services programs.