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Access to Care

Access to affordable, quality health care is important to physical, social, and mental health. Health insurance helps individuals and families access needed primary care, specialists, and emergency care, but does not ensure access on its own—it is also necessary for providers to offer affordable care, be available to treat patients, and be in relatively close proximity to patients.

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Why Is Access to Care Important to Health?

Together, health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met. 

In 2013, over 41 million Americans younger than age 65 were uninsured [1]. The Affordable Care Act (ACA) is projected to extend coverage to some but not all of these people. The uninsured are much less likely to have primary care providers than the insured; they also receive less preventive care, dental care, chronic disease management, and behavioral health counseling. Those without insurance are often diagnosed at later, less treatable disease stages than those with insurance and, overall, have worse health outcomes, lower quality of life, and higher mortality rates [2]. 

Neighborhoods with low health insurance rates often have fewer providers, hospital beds and emergency resources than areas with higher rates. Even the insured have more difficulty getting care in these areas [3].

Nationally, many areas also lack sufficient providers to meet patient needs; as of June 2014, there were about 6,100 primary care, 4,000 mental health, and 4,900 dental federally designated “Health Professional Shortage Areas” in the US [4]. Having a usual primary care provider is associated with a higher likelihood of appropriate care, and a usual source of care is associated with better health outcomes. In 2010, 86% of Americans had a usual source of care, but those with low incomes were less likely to than those with higher incomes, and the uninsured were twice as likely as the insured to lack a usual care source [2].

Cost can be a barrier to care even for those who have insurance. In 2009, 17% of people younger than 65 had premium and out of pocket costs totaling more than 10% of family income. Those with private, non-group insurance were three times as likely as those with employer-sponsored insurance to face such costs [2]. 

Adopting and implementing strategies that reduce barriers to care and better match providers to community needs can increase access to care, improving health and well-being.

What Is the County Health Rankings Measurement Strategy?

The County Health Rankings assess the extent of access to care with the following measures:

  • Uninsured is defined as the percentage of the population younger than age 65 without health insurance. The data for this measure come from the Census Bureau’s Small Area Health Insurance Estimates (SAHIE), which provide 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), the ratio of population to dentists in a county, and the ratio of population to mental health providers in a county. The primary care physician and dentist 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. The mental health provider measure is also based on data from the National Provider Identification file but utilizes the National Plan & Provider Enumeration system which lists each unique provider.

For more information about measuring Access to Care click here.

References

[1] Kaiser Commission on Medicaid and the Uninsured. Key facts about the uninsured population. Henry J. Kaiser Family Foundation; October 2014. Fact sheet.
[2] Clancy C, Munier W, Brady J, et al. 2012 National healthcare quality report. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2013.
[3] Robert Wood Johnson Foundation (RWJF). What is the link between having health insurance and getting adequate health care? Princeton: Robert Wood Johnson Foundation (RWJF); August 2011. Health policy snapshot.
[4] US Department of Health and Human Services. Health Resources and Services Administration (HRSA). Shortage designation: Health professional shortage areas & medically underserved areas/populations. Last reviewed June 1, 2014. Accessed March 4, 2015.