HEALTH-CARE COVERAGE - TRADITIONAL AND PREVENTIVE MEASURES AND ASSOCIATIONS WITH CHRONIC DISEASE RISK-FACTORS

Physician counseling of patients on health related activities is an es sential component of chronic disease prevention, however this requires patients to have ready access to health care providers. Previous stud ies have explored access to health care in terms of health plans and c ost without accounting for the lack of preventive coverage inherent in many insurance policies. This study compares two measures of health c are access, one using an assessment of cost and health plan availabili ty, and a new coverage measure including preventive services. Data was collected from 2574 adult respondents to the 1991-92 Missouri Behavio ral Risk Factor Surveillance System Surveys. Odds ratios were generate d for demographic variables, health related behaviors and preventive s creening and the two coverage measures. Using health plan and cost 22% lacked full coverage, however including availability of preventive co verage almost 60% lacked full coverage for preventive care. For both c overage measures significant associations were found with age, exercis e, marital status, routine checkup and mammography screening. Using th e measure of coverage of preventive services, rural residents and thos e who had never had cholesterol screening were more likely to lack cov erage. Inclusion of preventive care in measures of health care coverag e may alter previously reported associations with socio-demographic an d health related factors. Policy makers should realize that including preventive services in health care coverage greatly increases the numb er of individuals lacking adequate coverage, and that those lacking ad equate coverage are the least likely to undergo preventive screening.