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How economic demand influences access to medical care for rural Hispanic children
M W Smith1, R A Kreutzer, L Goldman
1Human Population Laboratory, California Department of Health Services, Berkeley 94704, USA.
Insights
In rural communities, low demand, not just unmet needs, limits physician availability. This impacts access to care for low-income, diverse populations, highlighting the need for facilitated access and economic rationale for services.
Area of Science:
- Public Health
- Health Services Research
- Rural Health
Background:
- Access to medical care in rural areas is a persistent challenge.
- Understanding the interplay between unmet needs and physician availability is crucial for improving healthcare delivery.
- Socioeconomic factors significantly influence healthcare-seeking behaviors.
Purpose of the Study:
- To analyze the relationship between factors influencing demand for medical care, local unmet needs, and physician availability.
- To examine the underutilization of medical services in low-income, diverse populations.
- To assess the adequacy of physician resources in a rural California community.
Main Methods:
- A study in McFarland, CA, screened 1,697 children aged 1-12 years.
- Multiple logistic regression analyzed the relationship between demand and unmet needs.
- Factors influencing demand included ability to pay, desire for care, and incidental costs.
Main Results:
- Eighty-six percent of children were of Mexican ancestry, with high unmet needs but low demand.
- 46% of families lived below the poverty level.
- Despite a need for four primary care physicians, only one could be supported privately due to low demand.
Conclusions:
- The demand model explains underuse of services in low-income areas despite high need.
- It provides an economic rationale for targeted services for underserved populations.
- It estimates resource gaps and highlights the necessity of facilitated access for certain groups.
Objectives:
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.