Access to medical care in a medically indigent population

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Abstract
Objective:To study the nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers. Design:Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated. Setting:A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population. Patients:200 patients who presented to eligibility workers seeking financial assistance. Interventions:None. Measurements and Results:Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find care. Conclusions:Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care.

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