Why Do We Measure It?
The number of Americans who do not have health insurance continues to increase. Additionally, there are disparities in access to care based on race/ethnicity, employment, gender, and income level. Ethnic minorities are more likely to be uninsured than non-Hispanic whites.
Evidence shows that
- The uninsured are less likely to receive preventive and diagnostic health care services, are more often diagnosed at a later disease stage, and on average receive less treatment for their condition compared to insured individuals.
- The uninsured population has a 25% higher mortality rate than the insured population.
Evidence suggests that access to effective and timely primary care has the potential to improve the overall quality of care and help reduce costs. One analysis found that each increase of one primary care physician per 10,000 population is associated with a reduction in the average mortality by 5.3%.
Untreated dental disease can also lead to serious health effects including pain, infection, and tooth loss. Although lack of sufficient providers is only one barrier to access for oral health care, much of the country suffers from shortages.
Some populations experience additional barriers in access to preventive health services due to lack of transportation to providers' offices, lack of knowledge about preventive care, long waits to get an appointment, low health literacy, and inability to pay the high-deductible of many insurance plans and/or co-pays for receiving treatment.
Many measurement strategies have been used for analyzing access to health care. They include the
- percentage of the population with and without health insurance,[6,7]
- percentage of employers offering health insurance to employees,
- percentage of the population that could (or could not) get medical care when needed,[6,7]
- number of patients served by a federally qualified health center (FQHC),
- percentage of the population using emergency rooms as the usual source of care, and
- availability of primary care providers in a community.
What Is the County Health Rankings Measurement Strategy?
The County Health Rankings represent access to care with the following measures:
- Uninsured is defined as the percentage of the population under age 65 without health insurance. The data for this measure come from the Census Bureau’s Small Area Health Insurance Estimates (SAHIE), which provides model-based estimates of health insurance coverage for all states and counties in the United States.
- The other measures report the ratio of population to primary care physicians in a county (i.e., the number of people per primary care physician) and the ratio of population to dentists in a county. The measures are based on data obtained from the Health Resources and Services Administration (HRSA). HRSA compiles physician and dentist data from the American Medical Association Master file and the National Provider Identification file respectively and from the Census Population Estimates program to report primary care physician and dentist data at the county level.
 Hall A, Harris Lemak C, Steingraber H, et al. Expanding the definition of access: It isn't just about health insurance. J Health Care Poor Underserved. 2008;19:625-638.
 Fronstin P. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2009 Current Population Survey. Employee Benefit Research Institute; 2009. EBRI Issue Brief no. 334.
 Institute of Medicine. Hidden Costs, Value Lost: Uninsurance in America. Washington, DC: Institute of Medicine;2003.
 Steinbrook R. Easing the shortage in adult primary care -- Is it all about money? N Engl J Med. 2009;360:2696-2699.
 Macinko J, Starfield B, Shi L. Is primary care effective? Quantifying the health benefits of primary care physician supply in the United States. Intl J Health Serv. 2007;37:111-126.
 Berk ML, Schur CL. Measuring access to care: Improving information for policymakers. Health Aff. 1998;17:180-186.
 Robert Wood Johnson Foundation. SHADAC state health access profile. Robert Wood Johnson Foundation Web Site.