Trends in Americans' Access to Needed Medical Care, 2001-2003

Originally published by the Center for Studying Health System Change (HSC) as Tracking Report No. 10, August 2004.

Americans' Access to Needed Medical Care, 2001-2003

Despite sluggish economic growth and rapidly rising health care costs, Americans' access to needed medical care improved between 2001 and 2003, particularly among low-income children and adults. The proportion of Americans reporting unmet medical needs declined by 0.5 percentage points, equivalent to roughly 1 million fewer people going without needed care, while those delaying care fell by 1.1 percentage points, or about 2 million people, according to findings from HSC's nationally representative Community Tracking Study Household Survey.

These improvements reversed a trend of increasing access problems that had been documented between 1997 and 2001. The gains were not simply a reflection of changes in income, insurance coverage, or other individual characteristics, suggesting that health system factors contributed to the improvement.

Gains for Vulnerable Populations

Low-income, uninsured Americans saw meaningful improvement, with the proportion reporting unmet medical needs falling by 3.2 percentage points to 13.2 percent in 2003. For low-income children, access improvements were particularly striking: income-related differences in access to care for children had essentially disappeared by 2003, a notable achievement given persistent gaps in earlier survey waves.

However, the overall picture remained concerning. About 14 percent of the U.S. population, roughly 39 million people, still reported not getting or delaying needed medical care in 2003. Approximately 15 million Americans reported an unmet medical need at some point during the previous 12 months, while another 24 million delayed care they believed they needed.

Cost Barriers Grow While Plan Barriers Recede

Among those reporting access problems, the nature of the barriers was shifting. Cost-related barriers to care increased over the survey period, with more Americans citing the expense of medical care as a reason for going without needed services. At the same time, concerns related to health plan restrictions, such as difficulties obtaining referrals or pre-authorization for services, and other system-related barriers declined. This pattern suggested that as health plans moved away from tightly managed care models of the 1990s, administrative barriers to care eased, but the accompanying shift to higher patient cost sharing created new financial obstacles for some patients.

An exception to the overall improvement was people reporting fair or poor health, who did not see gains in access. This population, which typically has the greatest need for medical services, remained at elevated risk of going without needed care despite improvements among other groups.

Sources and Further Reading

Strunk, Bradley C., and Peter J. Cunningham, "Trends in Americans' Access to Needed Medical Care, 2001-2003," Tracking Report No. 10, Center for Studying Health System Change (August 2004).