Litaker D, Einstadter D; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 8.
Case Western Reserve University, 573 Solon Road, Bentleyville, OH 44022; Tel: (216) 778-5210; Fax: (216) 778-3945; E-mail: wrightlit@aol.com
RESEARCH OBJECTIVE: To compare individual and health system characteristics for regions in Ohio with high and low unmet health care needs. STUDY DESIGN: Using the zip code of each respondent, we employed spatial analysis to identify single or multiple adjacent zip-code areas or clusters" where unmet health care needs (reported inability to obtain needed care of any type, prescriptions or medical equipment) were statistically higher or lower than expected. We compared high and low unmet need clusters using data on Ohio hospitals obtained from a state registry of short-term medical/surgical hospitals. POPULATION STUDIED: A subsample of 3245 respondents to the 1998 Ohio Family Health Survey, a state-wide survey of insurance, health care utilization and access in Ohio, living in areas in which unmet health care needs were statistically higher or lower than the state average. PRINCIPAL FINDINGS: A total of 15,622 individuals responded to this cross sectional survey in which average unmet need was 6%. A sub-sample of 3,245 (20.9%) respondents resided in 27 clusters where unmet need was significantly higher (mean=15.7%) or lower (mean=3.4%) than expected in 13 and 14 areas, respectively. Compared with low-need areas, residents of high-need clusters were more likely to be black (37 vs. 4.4%, p< .001), intermittently or uninsured in the past 12 months (23 vs. 11%, p<.001), have less than a high school education (20.8 vs. 7.6%, p<.001), and have family income < 134% of the federal poverty level (30.1 vs. 12.3%, p<.001). Respondents in high-need areas were also more likely to report their general health as fair-poor (21.3 vs 9.8%, p<.001) and to report one or more chronic medical conditions (43.4 vs 33.4%, p<.001). Although the median number of hospitals within a 20 mile radius was greater (10 vs. 4, p<.001), fewer residents in high-need clusters reported having a usual source of care (78.9 vs. 85.4%, p=.003) and more reported that the overall quality of care they received was fair or poor (6.6 vs. 2.1%, p<.001). Residents of these high-need areas also reported more frequent hospitalizations (p=.01) and ER visits (p<.001), but fewer dental care visits(p<.001). Areas of high unmet need were located in urban and non-urban settings; there was no association between need and federally designated health profession shortage areas for primary, mental health or dental care. CONCLUSIONS: Dramatic differences in hospital-based health care resources and individual characteristics exist in Ohio. A causal relationship between greater resources and greater need, however, can not be established with these cross sectional data. Similarly, assuming these resources are equally accessible to all local residents despite their individual characteristics invites an ecologic fallacy. Indeed, the prevalence of lower satisfaction with care and fewer residents with usual sources of care in regions of high unmet need and greater resources suggests this may not be the case. Longitudinal studies are needed to examine these relationships in greater detail. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Allocating greater health system resources to areas with high unmet needs does not guarantee improvements in access. These data suggest the need to develop and implement regional measures of access effectiveness and equitability.
Publication Types:
Keywords:
- Cross-Sectional Studies
- Delivery of Health Care
- Dental Care
- Health Resources
- Health Services Accessibility
- Health Services Needs and Demand
- Income
- Longitudinal Studies
- Medically Uninsured
- Ohio
- Poverty
- hsrmtgs
Other ID:
UI: 102274161
From Meeting Abstracts