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 Outcomes 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.