Understanding the Health Care Needs of the Medically Indigent of Grayson County

Results

Frequencies for Dependent and Independent Variables

Refused care or surgery. The dependent variable in this analysis is difficulty getting medical care in the past year. This variable was measured by the response to the following question:

Sometimes people have difficulties in getting medical care when they need it. During the past 12 months, was there a time when you wanted medical care or surgery but could not get it? (1) Yes (2) No

Ten people, or 20% of the sample, reported they could not get medical care or surgery that they needed in the past 12 months. When asked why they could not get the care they needed, the most common reasons given were: could not afford it (9 people), had no insurance (6), doctor did not accept Medicaid or insurance (4), no doctor was available (3), had to wait too long in office or clinic (3), had difficulty getting an appointment (1), did not know where to go (1), had no way to get to care (1), the hours were not convenient (1), health of another family member prevented getting care (1), and the doctor said patient did not need care (1). When the patient could not get medical care, seven respondents said their health problem was very serious and five respondents said it was somewhat serious. More than half (7) of the people who had not been able to get the care they needed were eventually able to get care.

Predisposing variables. Among the predisposing variables, data were collected on the respondent’s sex, age, marital status, and language spoken in the home. Thirty-four participants out of 50 were females and 16 were male. The participants ranged in age from 18 to 86. Eight people were between the ages of 18 and 35. Ten participants were in the age range of 36 to 56. Ten were between the ages of 57 and 64. Nine people were 65 or older. Only 37 participants reported their age. Over half (59.6%) of the participants reported being married and currently living with a spouse while 40.4% reported they were not currently married and living with a spouse. The interviews were all conducted in English and all the households spoke English. Two of the households also spoke Spanish. Paperwork was a big problem in getting care for 33.3% of the respondents; 12.2% reported they had problems with transportation.

Enabling variables. Among the enabling variables, we measured employment status, insurance coverage, barriers to care, and competing needs for income. One-third (34.5%) had a job or were employed in the past 12 months. Of the respondents who reported being employed, 57.1% worked for more than 35 hours a week and 33.3% worked less than 20 hours a week. More than one-third (38.1%) reported that they worked for a private company or organization. Twenty-eight percent of the respondents said they had insurance through their work while 20.4% were insured through their spouse’s work. Thirty percent (30.6%) said that they had private insurance while 34% had Medicare and 14% had Medicaid. Ten percent (10.2%) reported having military or veteran coverage. Seven people reported that they had no coverage. Interestingly, 27.7% of the respondents reported that they could not get care in the past 12 months because they had to use the money to pay for food, clothing, and housing.

Need variables. The interview included nine questions measuring the respondent’s perception of health, including:

(1) health status
(2) needs help with personal needs like eating, bathing, and dressing
(3) needs help with household chores
(4) has difficulty with memory or confusion
(5) has activity limitation due to physical, mental, or emotional problems
(6) how often gets enough sleep
(7) how often feels full of energy
(8) how often feels sad, blue, or depressed
(9) rating of happiness.

Among the respondents, 6% reported that their health was poor; 22% reported fair health; 22% reported good health; 38% reported very good health; and 12% said their health was excellent. Ten percent of the respondents said they require help with personal needs like eating, bathing, and dressing, and 26% said they needed help with household chores like shopping and getting around. Eighteen percent (18.4%) reported having difficulty walking without special equipment. Thirty percent (30.6%) said they had difficulty remembering or experienced periods of confusion. Almost half (42.9%) were limited because of physical, mental, or emotional problems. When asked how often they felt they did not get enough sleep or rest in the past 30 days, 36% said that they had gotten enough rest some days but not most, and 16% said most days. In response to the question about how often they felt full of energy in the past 30 days, 52.1% reported some days but not most, and 25% reported most days. Close to half (46.8%) reported that they felt sad, blue, or depressed some days but not most, and 14.9% reported they felt sad or depressed every day for the past 30 days. In response to the question about how happy they were, 35.6% said that they were very happy, 31.1% were pretty happy, and 33.3% were somewhat happy.

Significant Predictor Variables for Difficulty Getting Medical or Surgical Care

Age. Age is a significant predictor of difficulty getting medical or surgical care. As shown in Table 1, 40% of the respondents between the ages of 18 and 44 reported they could not get surgery or medical care in the past 12 months. Twenty percent (22.2%) of the respondents between the ages of 45 and 64 reported they could not get surgery or medical care in the past 12 months. Among those age 65 or older, no one reported not being able to get surgery or medical care in the past 12 months. The relationship was significant (chi-square = 4.480, df = 2, p = .05), and very strong (gamma = .684).

Marital status. Marital status was a strong significant predictor of difficulty getting medical or surgical care (chi-square = 4.613, df = 1, p = .038, gamma = -.659). As shown in Table 2, 36.8% of people who were not currently married or living with a spouse reported they could not get surgery or medical care in the past 12 months versus 10.7% of people who were currently married or living with a spouse.

Feeling healthy and full or energy. Feeling healthy and full of energy was a strong significant predictor of difficulty getting medical or surgical care (chi-square = 2.655, df = 1, p = .103, gamma = -.680) (see Table 3). Almost one-third (27.3%) of the people who said they felt healthy or full of energy some days or never reported not being able to get medical care or surgery in the past 12 months. Of those who reported feeling healthy or full of energy most days or everyday, 93.3% said they did not have difficulty getting surgery or medical care in the past 12 months.

Health status. Health status was a moderate significant predictor of difficulty getting medical or surgical care (chi-square = 3.001, df = 1, p = .093, gamma = -.350) (see Table 4). Of the people who reported fair or poor health, 35.7% reported not being able to get surgery or medical care in the past 12 months compared to only 13.9% of people with good to excellent health.

Competing needs. Finally, putting off health care because of competing needs for food, clothing, or housing was a very strong, significant predictor of difficulty getting medical or surgical care (chi-square = 17.392, df = 1, p = .000, gamma = .925). Over half (61.5%) of the respondents who reported not receiving care or medicine in order to buy food, clothing, or pay for housing said they could not get surgery or medical care in the past 12 months.