How economic demand influences access to medical care for rural Hispanic children.
OBJECTIVE
In a study of access to medical care, the authors analyzed the relationship between factors influencing demand, local unmet needs, and the availability of physicians in a rural California community.


METHODS
The California Department of Health Services screened 1,697 (90%) of children aged 1 to 12 years in McFarland, CA. The relation of demand to unmet needs was examined using multiple logistic regression. Factors influencing demand for medical care were: ability to pay (income, health insurance) desire to purchase care (ethnicity, education, perceived need), and incidental costs (transportation, child care, etc). Questions from the Hispanic Health and Nutrition Survey were reconstrued to fit the demand model. Local need and demand for physicians was compared with state levels to assess whether sufficient physicians were available.


RESULTS
Eighty-six percent of the children were of Mexican ancestry. Factors influencing demand were linked with specific unmet needs. Although unmet needs were high, demand was low; 46% of all families were below the poverty level. Although four primary care physicians were needed, only one could be supported in the private sector because of low demand.


CONCLUSIONS
Advantages to the demand model are: (1) it shows why medical services are underused and lacking in low-income areas although need is high, (2) it permits an economic rationale for extra services for poor diverse populations, (3) it estimates the amount of resources lacking to assure adequate levels of care, (4) it shows why facilitated access is needed for certain groups.
Smith
M W
MW
Human Population Laboratory, California Department of Health Services, Berkeley 94704, USA.
Kreutzer
R A
RA
Goldman
L
L
Casey-Paal
A
A
Kizer
K W
KW
D002140:California; D002648:Child; D002675:Child, Preschool; D003729:Dental Care / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008800:Mexico / Q000208:ethnology; D011203:Poverty; D011295:Prenatal Care / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors