Accessibility to medical care among urban American Indians in a large metropolitan area.

Federal health and medical care programs recently mandated for American Indians living in cities are predicated upon information pertaining to their unmet health needs and assessments of their accessibility to medical care. Based upon a household survey conducted among a representative Indian population living in a large metropolitan area, an evaluation is made of the accessibility experience of this population as it pertains to primary medical care. Using measures of accessibility including travel time, appointment delay time, and waiting room time, the experiences of Indian residents of major residential sections of the area are illustrated. Comparative assessments are made on the basis of the individual convenience factors as well as on the basis of an aggregate index of accessibility that has been proposed for health planning and evaluation. Significant differences in accessibility to primary care between residents in certain residential areas are demonstrated and suggestions for revision of the accessibility standards are offered.