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---------------------------------------------------------------------------- One in four has trouble getting medical care, survey shows ---------------------------------------------------------------------------- (October 7, 1997 11:10 a.m. EDT http://www.nando.net) -- Nearly a quarter of U.S. families report it has become more difficult to get medical care in the past three years, while nearly one in five family doctors say they can't always obtain referrals to high quality specialists. A survey released Tuesday found that 24 percent of families felt it had become harder to get the care they need, while 12 percent felt it had become easier and 64 percent saw no change. The surveys of 24,000 households and 9,000 doctors, conducted last winter by the Center for Studying Health System Change, found that concerns about access to care extend across economic boundaries, but also vary among communities. "We found that in places where families are more anxious about being able to get care, like Miami, Newark and Phoenix, primary care physicians are also more doubtful about being able to provide patients with what they consider to be high quality care," said Dr. Robert St. Peter, one of the principal researchers in the studies. Boston, Lansing, Mich., and Syracuse, N.Y. scored best among both families and doctors for access to care among 12 locations involved in a community tracking study. Although managed care "gatekeeping" requirements had some effect on the responses, St. Peter said, he and other analysts believe other factors also had a role, such as how many people in an area are uninsured, or how many specialists are available in a particular market. "The extent of penetration of managed care may matter less than how many people are new to it," St. Peter said. "For instance, a community where the share of families enrolled in HMOs goes from 5 to 10 percent may feel more disruption than one in which the share goes from 40 to 45 percent.It's the change that generates the anxiety." Low income families were more likely than average (30 percent) to report worsening access to care, but the lack of health insurance was an even greater factor. Forty-one percent of families with no health coverage at the time of the survey reported more difficulty getting medical treatment, compared with 21 percent among families that had private health insurance. The physicians survey found that the majority of doctors either "agree strongly" (45 percent) or "agree somewhat" (31) percent, that "It is possible to provide high-quality care to all my patients." But that left 22 percent disagreeing that they can always provide high quality care (another 2 percent said they neither agreed nor disagreed). "We worked hard to refine our question so it filtered out doctors bellyaching about having to fill out more paperwork or spend another five minutes on the phone to get a referral, and focus on whether they were able to get patients care they thought was genuinely medically necessary," St. Peter said. The doubts about quality care were even higher among specialists (27 percent), but were still entertained by 18 percent of the more than 3,000 primary care doctors in the survey. "That's a pretty alarming level among the doctors who are supposed to be making the calls on the care people receive," said St. Peter, himself a primary care doctor. The center conducted the surveys as part of an ongoing monitoring program supported by the Robert Wood Johnson Foundation. The other communities in the tracking survey were Cleveland, Greenville, S.C., Indianapolis, Little Rock, Orange County, Calif., and Seattle. By LEE BOWMAN, Scripps Howard News Service Copyright 1997 Nando.net Copyright 1997 Scripps Howard <http://www.nando.net/newsroom/ntn/health/100797/health3_3736_noframes.html> [log in to unmask]