Access to health care services among people with chronic or disabling conditions: patterns and predictors 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilton SA. Access to health care services among people with chronic or disabling conditions: patterns and predictors. Arch Phys Med Rehabil 2003;84:1417–25. 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.