Nonfinancial barriers and access to care for U.S. Adults

Objective. To identify prevalences and predictors of nonfinancial barriers that lead to unmet need or delayed care among U.S. adults. Data Source. 2007Health TrackingHousehold Survey. Study Design. Reasons for unmet need or delayed care in the previous 12 months were assigned to one of five dimensions in the Penchansky and Thomas model of access to care. Prevalences of barriers in each nonfinancial dimension were estimated for all adults and for adults with affordability barriers. Multivariable logistic regression models were used to estimate associations between individual, household, and insur-ance characteristics and barriers in each access dimension. Principal Findings. Eighteen percent of U.S. adults experienced affordability barri-ers and 21 percent experienced nonfinancial barriers that led to unmet need or delayed care. Two-thirds of adults with affordability barriers also reported nonfinan-cial barriers. Young adults, women, individuals with lower incomes, parents, and per-sons with at least one chronic illness had higher adjusted prevalences of nonfinancial barriers. Conclusions. Nonfinancial barriers are common reasons for unmet need or delayed care among U.S. adults and frequently coincide with affordability barriers. Failure to address nonfinancial barriers may limit the impact of policies that seek to expand access by improving the affordability of health care. Key Words. Access to care, nonfinancial barriers, health reform The recently enacted Patient Protection and Affordable Care Act (PPACA) seeks to increase access to health care for U.S. adults by improving the afford-ability of health services (Patient Protection and Affordable Care Act 2010). To achieve this goal, the law requires private health insurance plans to allow young adults to remain as dependents on their parents ’ plans and eliminate cost-sharing for evidence-based clinical preventive services. It will als