Time Trends and Disparities in Access to Care for US Families

We sought to determine time trends and disparities in the risk of unmet healthcare need among families in the US over the past ten years, using a nationally representative, population-based sample. We examined data on 347,526 families from the 2001-2010 National Health Interview Survey. Unmet healthcare need was defined as delayed or forgone healthcare during the past 12 months due to cost, among any family member. Multivariable logistic regression was used to model adjusted time trends in the family-level risk of unmet need by examining interactions between chronologic time and family-level covariates (including race/ethnicity, education, employment, marital status, geographic region, family size and composition, income, insurance, activity limitations, usual source of care, past year healthcare utilization and past year expenditures). In the past decade, the US saw a steep rise in the risk of unmet healthcare need from 13.3% in 2001 to 19.8% in 2010. Multivariate regression results indicated that uninsured families had the highest risk of unmet need (AOR: 7.4, 95% CI: 7.1-7.7), followed closely by families with partial/intermittent insurance (AOR: 5.7, 95% CI: 5.5-5.9). While the publicly insured had higher odds of unmet need than privately insured families, publicly insured families experienced the smallest increase in unmet need over the ten year period, such that this disparity was virtual eliminated. Initially, families with incomes below 400% of the federal poverty level (FPL) were two to three times as likely to incur unmet need as families above 400% FPL; however, the risk of unmet need among families above 400% FPL increased rapidly over time compared to their counterparts, narrowing this income disparity. There were additional important sociodemographic differences in time trends during the study period. The risk of unmet healthcare need is an increasing problem in the US; and there are clear disparities in the risk for and trends of unmet need. Reducing unmet need may improve long-term family health outcomes by increasing the opportunity to receive timely and preventive care. As protective factors such as income and private insurance appear to be decreasingly protective, new strategies should be adopted to promote timely and appropriate healthcare utilization without placing undue burden on already vulnerable populations.