Americans in general are seeing their doctors less often than they did in 1982, but the poor--Latinos in particular--have experienced such a deterioration in access to health care that the national foundation which sponsored a new survey says the situation has become a "crisis."
President Reagan's "safety net," a guarantee of services to protect the health and welfare of the poor, "has holes in it," said UCLA sociologist Howard Freeman, who headed the survey, "big holes."
And health-care observers unaffiliated with the study say the trend represents an almost inevitable result of belt-tightening in the medical community and overall changes in the U.S. economy since 1980. "I'm afraid (the problem of access to health care) will get worse before it gets better," said Columbia University medical economist Eli Ginzberg. "I see nothing on the horizon that assures me we are anywhere near coming to grips with this problem sensibly."
The erosion in access to health services was so pronounced among the poor, that when the study was first shown to the sponsoring Robert Wood Johnson Foundation, executives ordered a reanalysis because they could not believe such radical worsening in just four years.
But the reanalysis confirmed the original conclusions. Results were released in Washington on Thursday. The survey, in which 10,130 persons were questioned nationwide, found that:
The proportion of Americans who had not visited a doctor's office in the preceding 12 months increased from 19% in 1982 to 33% in 1986. They survey found 17.7% of Americans, or 43 million people, said they had no regular source of health care--no regular doctor, clinic or hospital--up from 11% four years before. Among Latinos, the proportion with no regular source of care tripled in four years, from 10% to 30%.
Hospital-use rates dropped in general, from 9% to 7%, but declined even more for the poor, who went from 10.4% to 7.9%, than the non-poor, whose hospital use fell from 8.8% to 6.2%. Among the poor, Latinos had the lowest hospital-use rates--just 4.5%, down from 6.3% in 1982. Rates of emergency room visits overall went up 12% in four years--implying, sur veyors said, that many people turned away from or unable to afford routine care ended up in emergency departments--often after their conditions deteriorated.
A total of 16%, or 38 million Americans, reported they had difficulty getting health care even though they needed it. Strictly economic reasons accounted for most of the disparity, with 6% of all respondents overall saying they were financially strapped when it came to health, but with 9% of blacks, 7% of Latinos and 13% of people not covered by health insurance saying they could not afford care.
About 1 million Americans--0.4% of the population--were turned away at doctors' offices or hospitals because they could not pay. An additional 2 million people had to pay at least $1,500 of their own money in their last contact with the health system.
Children, pregnant women and the very sick either could not afford, find or get much of the care they needed. A total of 17% of people with a chronic illness had not seen a doctor in a year--the proportion was highest among blacks, at 25%. Nationally, 15% of pregnant women got no health care during their first trimesters, with rates double that for low-income women. Twenty percent of people with hypertension had not had their blood pressures checked in a year, with blacks and Latinos recording 30% each.
Headquartered in Princeton, N.J., the Robert Wood Johnson Foundation generally enjoys a reputation as a solid research center. In the last several years, it has collaborated with government agencies on programs and worked to resolve a wide range of problems, from housing and health care for the elderly to the treatment of AIDS patients. In that context, the report released Thursday was significant in part because of the element of urgency it conveyed.
"The most disturbing findings of the 1986 (survey) involve the deterioration in access and medical care among the nation's poor, minority and uninsured citizens," the report concluded. "A number of improvements noted in 1982 have been reversed. These changes are real . . . and have had a serious impact on the segments of the American population least able to take advantage of the various new forms of health-care delivery or to pay for the care they so evidently need."
While the deterioration in access to health-care services was striking in terms of its degree, many experts said, the new developments noted by the survey were hardly unexpected. Beginning with passage of the Medicare and Medicaid (Medi-Cal in California) programs in the mid-1960s, survey after survey had noted significantly improved access to health services among the poor.