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Nonfinancial Barriers and Access to Care for U.S. Adults

Authors

  • Jeffrey T. Kullgren,

    Corresponding author
    1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
    • Robert Wood Johnson Foundation Clinical Scholars, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, PA
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  • Catherine G. McLaughlin,

    1. Mathematica Policy Research, Inc., the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
    2. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Nandita Mitra,

    1. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Katrina Armstrong

    1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
    2. Abramson Cancer Center and the Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
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Address correspondence to Jeffrey T. Kullgren, M.D., M.S., M.P.H., Robert Wood Johnson Foundation Clinical Scholars, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, 1303B Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail: kullgren@mail.med.upenn.edu.

Abstract

Objective

To identify prevalences and predictors of nonfinancial barriers that lead to unmet need or delayed care among U.S. adults.

Data Source

2007 Health Tracking Household Survey.

Study Design

Reasons for unmet need or delayed care in the previous 12 months were assigned to one of five dimensions in the Penchansky and Thomas model of access to care. Prevalences of barriers in each nonfinancial dimension were estimated for all adults and for adults with affordability barriers. Multivariable logistic regression models were used to estimate associations between individual, household, and insurance characteristics and barriers in each access dimension.

Principal Findings

Eighteen percent of U.S. adults experienced affordability barriers and 21 percent experienced nonfinancial barriers that led to unmet need or delayed care. Two-thirds of adults with affordability barriers also reported nonfinancial barriers. Young adults, women, individuals with lower incomes, parents, and persons with at least one chronic illness had higher adjusted prevalences of nonfinancial barriers.

Conclusions

Nonfinancial barriers are common reasons for unmet need or delayed care among U.S. adults and frequently coincide with affordability barriers. Failure to address nonfinancial barriers may limit the impact of policies that seek to expand access by improving the affordability of health care.

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