Chartbook on Access to Health Care

• Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (IOM, 1993). 
• Access to health care consists of four components (Healthy People 2020): 
  • Health insurance: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status. 
  • Services: having a usual source of care is associated with adults receiving recommended screening and prevention services. 
  • Timeliness: ability to provide health care when the need is recognized. 
  • Infrastructure: capable and qualified workforce; updated health information technology.

Chartbook on Access to Health Care 

• This chartbook includes: 
  • Summary of trends across measures of Access to Health Care from the QDR.
  • Figures illustrating select measures of Access. 
• Introduction and Methods contains information about methods used in the chartbook. 
• Appendixes include information about measures and data. 
• A Data Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data tables.

Summary of Rates of Change of Access Measures

Average annual rates of change of access to care measures through 2012, by age 

Note: Each point represents one measure. Large red diamonds indicate median values. Access measures include insurance, usual provider, barriers to care, and timeliness of care. For most measures, trend data are available from 2001-2002 to 2012. For each measure with at least four estimates over time, weighted log-linear regression is used to calculate average annual percentage change. Measures are aligned so that positive change indicates improved access to care.

Trends:

• Through 2012, most access measures improved for children. The median change was 5% per year.
• Few access measures improved substantially among adults. The median change was zero.

Summary of Access Disparities

Access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group, 2012 

Key: AI/AN = American Indian or Alaska Native; n = number of measures. 

Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. The relative difference between a selected group and its reference group is used to assess disparities. 

• Better = Population had better access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group. 
• Same = Population and reference group had about the same access to care. Differences are not statistically significant or are smaller than 10%. 
• Worse = Population had worse access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

Disparities: 

• In 2012, people in poor households had worse access to care than people in high-income households on all access measures (green). 
• Blacks had worse access to care than Whites for about half of access measures. 
• Hispanics had worse access to care than Whites for two-thirds of access measures. 
• Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

Summary of Trends in Access Disparities

Number and percentage of all access measures for which disparities related to race, ethnicity, and income were improving, not changing, or worsening through 2012

Key: AI/AN = American Indian or Alaska Native; n = number of measures. 

Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For most measures, trend data are available from 2001-2002 to 2012. 

For each measure, average annual percentage changes were calculated for select populations and reference groups. Measures are aligned so that positive rates indicate improvement in access to care. Differences in rates between groups were used to assess trends in disparities. 

• Worsening = Disparities are getting larger. Differences in rates between groups are statistically significant and reference group rates exceed population rates by at least 1% per year. 
• No Change = Disparities are not changing. Differences in rates between groups are not statistically significant or differ by less than 1% per year. 
• Improving = Disparities are getting smaller. Differences in rates between groups are statistically significant and population rates exceed reference group rates by at least 1% per year. 

Disparity Trends: 

• Through 2012, most disparities in access to care related to race, ethnicity, or income showed no significant change (blue), neither getting smaller nor larger. 
• In four of the five comparisons shown, the number of disparities that were improving (black) exceeded the number of disparities that were getting worse (green).

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