Access to Health Care for the Poor: Does the Gap Remain?

In the last 15 years several federal programs were established to improve access to health care for disadvantaged groups. Although numerous studies have been conducted examining trends in access to health care, considerable controversy remains. Nearly all authors concur that important progress has been made, and that gaps in access to care have narrowed considerably. Some, however, go further and conclude that the evidence indicates that all significant gaps have been eliminated and access to health care is universally shared. Evidence on access to health care has important health policy implica­ tions. If the task of assuring access to health care has been largely accom­ plished, further expansion of federal health care programs to promote access would be unwarranted. If selected population groups lag behind others in access to care, targeted policies to close remaining gaps may be warranted for these groups. The reasons for any remaining gaps also have significant policy implica­ tions. If the major barriers to access are financial, expansion of eligibility for existing financing programs such as Medicaid or a new national health insurance plan may be needed to bring all poor persons into the health care system. If the major barriers are related to race or limited resources, a services or manpower strategy for underserved areas may be called for. If the remaining barriers are racial or limited knowledge about the importance of using the health care system, still other strategies may be appropriate.