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APHA Scientific Session and Event Listing

Recorded presentation

Keith Whitworth, MA, Department of Sociology, Texas Christian University, TCU Box 298710, Fort Worth, TX 76129, 817-257-5941, k.whitworth@tcu.edu, Susan Eve, PhD, Honors College, University of North Texas, P.O. Box 310529, Denton, TX 76203, Joane G. Baumer, MD, Department of Family Medicine, John Peter Smith Hospital, Family Health Clinic, 1500 South Main Street, Fort Worth, TX 76104, Ximena Urrutia, DrPH, Social and Behavioral Sciences, UNTHSC School of Public Health, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, Fernando Trevino, PhD, MPH, Office of the Dean, University of North Texas, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, and Kenneth Koelln, PhD, Department of Economics, University of North Texas, P.O. Box 305457, Denton, TX 76203-5457.

Objectives and theoretical framework. Objectives are to describe problems low-income white men have accessing healthcare in a safety-net network and to suggest public policies that can address their barriers to care. The Behavioral Model for Vulnerable Populations developed by Andersen, Aday, and Gelberg includes variables that predispose patients to use healthcare services, resources that enable people to use services when needed, and perceptions of health status. Methods. Data on 280 white men were taken from a random telephone survey of 2034 patients 18-60 years of age who used the JPS Health Network in July and August 2000. The network then included a comprehensive hospital and 12 community health centers located in Tarrant County, TX. Healthcare is available on a sliding scale to legal county residents with incomes up to 200% of the federal poverty level, and to other patients who pay for care out-of-pocket or with insurance. Major findings. 40% of the respondents were married and living with a spouse; and 70% were working, with 55% percent working 38 – 96 hours a week. 70% reported being uninsured. 41% reported that their health was excellent or very good, 31% that it was good, and 28% report only fair or poor health. The most common reasons for being uninsured were that respondents could not afford to pay insurance premiums (65%), they had lost jobs or changed employers (47%), and they had usually been healthy and had not needed insurance (47%). White male patients reported substantial problems getting health care they needed in the past 12 months even though they were enrolled in a safety-net system. Specifically, 24% had problems getting needed medical or surgical care, with 12% reporting being refused care by a doctor or hospital; 24% could not get a needed prescription medicine; and 38% reported problems getting needed dental care. A majority (61%) reported they had at least one visit to the emergency department in the past year and 22% had been hospitalized in the past six months. Finally, one-fourth reported foregoing healthcare or medicine in the past year to buy food, clothing, or housing for themselves or their families. Predictors of problems accessing healthcare services are presented using logistic regression analysis. Conclusions. Policy changes at the national, state and county levels that could increase access to services by vulnerable populations are discussed. Research supported by Texas Higher Education Coordinating Board, Advanced Research Program, #003594-0120-1999.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe low-income white men as a vulnerable population.
• Describe problems this vulnerable population has accessing healthcare providers, including physicians, hospitals, prescription medicines and dental care even in a safety-net system.
• Discuss policy options for counties for addressing healthcare access problems.

Keywords: Access and Services, Safety Net

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation