Access to health care services among people with chronic or disabling conditions: patterns and predictors.

OBJECTIVE To examine patterns of access to a variety of specific health care services among people with chronic or disabling conditions, focusing on factors that predict access to services. DESIGN National survey of 800 adults with cerebral palsy (CP), multiple sclerosis (MS), spinal cord injury (SCI), or arthritis. SETTING Respondents were surveyed in the general community. PARTICIPANTS National convenience sample of adults with CP, MS, SCI, or arthritis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Access to services from primary care doctors, services from specialists, rehabilitative services, assistive equipment, and prescription medications. Cross tabulations and logistic regression analyses were performed on survey data to examine patterns and predictors of access to health care services. RESULTS Only half of all respondents received needed rehabilitative services. Respondents covered by fee-for-service health plans were more likely than those covered by managed care organizations to receive needed services from specialists. Respondents with the poorest health and with the lowest incomes were the least likely to receive all health services examined. CONCLUSIONS People with chronic or disabling conditions often require a comprehensive array of health care services. Reform of the current health care payment and delivery structures is needed so that health care is more responsive to those with the greatest service needs.