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IntroductionKey FindingsNational InsightsOverviewAccess to Health CareImmunizationsChronic Disease PreventionInequity InsightsAccess to Health Care: Dedicated Health Care ProviderImmunizations: Pneumococcal VaccinationChronic Disease Prevention: Colorectal Cancer ScreeningState Insights: OverallState Insights: Access to Health CareState Insights: ImmunizationsState Insights: Chronic Disease PreventionAppendix 1Appendix 2Footnotes
Background
Access to health care is a key part of disease prevention. Individuals without health insurance often have more difficulty accessing the health care system, are less likely to participate in preventive care programs, and have more unmet health needs than those with health insurance. [iii] Although the number of Americans with health insurance has increased since the Affordable Care Act’s coverage expansion provisions took effect in 2014, approximately 30 million individuals are expected to be without health insurance in 2016. [iv]
Research shows uninsured individuals report poorer physical and mental health and have worse health outcomes, such as higher cancer mortality rates, than those with health insurance. [v], [vi],[vii] Additionally, individuals with a usual source of care use the emergency room less [viii] and receive more preventive health care services than those without. [ix] In fact, having health insurance and a usual source of care have been associated with first-time preventive care use. [x]
FIGURE 2: Access to Health Care National Goals 
HP2020 is an initiative led by the US Department of Health & Human Services to identify specific areas where the nation must take action to achieve better health by 2020. The program set forth the following two leading health indicators related to access to health services:
Oral health is a vital part of a comprehensive preventive health program. Oral health problems are preventable through routine visits to the dentist and good oral hygiene. Factors that influence individuals receiving dental care include access to dentists, cost, education, and motivation. [xi], [xii] Results of a recent study show that young adults are increasingly relying on the emergency room for dental problems. Being uninsured or Medicaid-insured were associated with emergency room dental care visits. [xiii]
Key Findings
Access to Health Care was examined using three measures: Health Care Coverage, Dedicated Health Care Provider, and Annual Dental Visit (Table 2). Two of the measures—Dedicated Health Care Provider and Health Care Coverage—are highly correlated with each other.
Looking at self-reported data for each of these measures individually reveals the following insights:
- 87.6% of adults report having some type of health insurance. This varies from a high of 95.4% in Massachusetts to a low of 75.1% in Texas.
- 76.7% of adults report having a personal doctor or health care provider. The percentage varies from 89.3% in Massachusetts to 64.8% in Nevada.
- 65.3% of adults report visiting the dentist or dental clinic in the past year. This varies from 74.9% of adults in Connecticut to 54.2% in West Virginia.
These data support research that indicates health insurance coverage provides an important entry point to the health care system.[xiv]
TABLE 2: Measures: Access to Health Care 
FIGURE 3: Access to Health Care: National Average and Range of State Values 
Figure 3 shows the national average as a diamond and how each state (blue dots) performs on the three access measures. Those states at the top perform better than the national average, while those at the lower ends have greater room for improvement. Among the Access to Health Care measures, dedicated health care provider has the greatest variation across states compared with annual dental visit and health care coverage. Looking at health care coverage, the majority of states are clustered around the national average, revealing that there is very little variation in the middle of the pack.
Footnotes
iii Ayanian JZ. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284(16):2061.
iv Congressional Budget Office. Insurance Coverage Provisions of the Affordable Care Act— CBO’s March 2015 Baseline. https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2015-03-ACAtables.pdf. Accessed February 8, 2016.
v Freeman JD. The causal effect of health insurance on utilization and outcomes in adults: A systematic review of US studies. Med Care. 2008;46(10):1023.
vi Ward E. Association of insurance with cancer care utilization and outcomes. Ca. 2008;58(1):9.
vii Finkelstein A, Taubman S, Wright B, Bernstein M, Gruber J, Newhouse J, et al. The Oregon Health Insurance Experiment: Evidence from the first year. The Quarterly Journal of Economics. 2012: 127(3):1057-1106.
viii Liaw W, Petterson S, Rabin D, Bazemore A. The impact of insurance and a usual source of care on emergency department use in the United States. International Journal of Family Medicine. 2014. doi:10.1155/2014/842847.
ix Access to Health Services. Healthy People 2020. http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. Accessed January 28, 2016.
x Gai Y, Feng L. Factors Associated with First-Time Use of Preventive Services in the United States. Am J Health Behav. 2013; 37(2):257-268.
xi Bloom B, Simile CM, Adams PF, Cohen RA. Oral health status and access to oral health care for U.S. adults aged 18–64: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat. 2012. 10(253).
xii US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Oral Health in America: A Report of the Surgeon General. Rockville, MD: National Institutes of Health, National Intsitute of Dental and Craniofacial Research; 2000.
xiii Lewis C, McKinney CM, Lee HH, et al. Visits to US emergency departments by 20 to 29-year-olds with toothache during 2001–2010. J AM Dent Assoc. 2015; 146(5): 295–302.
xiv Centers for Disease Control and Prevention. Health Insurance and Access to Care. NCHS Fact Sheet: November 2015. http://www.cdc.gov/nchs/data/factsheets/factsheet_hiac.pdf. Accessed January 28, 2016.