Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital.
OBJECTIVE
To determine the correlation among obstacles to medical care, lack of a regular source of care, and delays in seeking care.


METHODS
Cross-sectional survey of patients presenting for ambulatory care during a 7-day period. Multiple logistic regression models were used to identify obstacles independently associated with outcome variables.


METHODS
Urban public hospital.


METHODS
A total of 3897 disadvantaged and predominantly minority patients.


METHODS
Lack of a regular source of medical care and delay in seeking medical care for a new problem.


RESULTS
The majority (61.6%) of patients reported no regular source of care. Of 2341 patients reporting a new medical problem, 48.4% waited more than 2 days before seeking medical care. No health insurance (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.89 to 2.61), no transportation (OR, 1.44; 95% CI, 1.23 to 1.70), exposure to violence (OR, 1.21; 95% CI, 1.08 to 1.45), and living in a supervised setting (OR, 1.50; 95% CI, 1.00 to 2.25) were independent predictors of lack of a regular source of care. No insurance (OR, 1.24; 95% CI, 1.02 to 1.51), no transportation (OR, 1.45; 95% CI, 1.19 to 1.77), and less than a high school education (OR, 1.22; 95% CI, 1.08 to 1.49) were independent predictors of delaying care for a new medical problem.


CONCLUSIONS
Obstacles in addition to lack of insurance impede provision of medical care to disadvantaged patients. The adoption of universal health care coverage alone will not guarantee access to appropriate medical care.
Rask
K J
KJ
Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA 30303.
Williams
M V
MV
Parker
R M
RM
McNagny
S E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006773:Hospitals, Municipal / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors