BARRIERS TO THE USE OF PREVENTIVE HEALTH-CARE SERVICES FOR CHILDREN

THIS ARTICLE DESCRIBES findings from interviews of parents targeted fo r outreach efforts that encouraged them to use Medicaid's Early and Pe riodic Screening, Diagnosis and Treatment (EPSDT) Program. Begun in th e 1970s, the EPSDT Program held out the promise of ensuring that needy children would receive comprehensive preventive. health care. With on ly one-third of eligible children in the United States receiving EPSDT checkups,the program has yet to fulfill its promise. This study sough t to understand parents' perceptions of barriers to using EPSDT by int erviewing (a) 110 parents who did not schedule EPSDT checkups for thei r children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling an d transportation, these low-income parents identified significant barr iers to care. Reasons for not using EPSDT services included (a) compet ing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and jc) issues related directly to problems with the outreach efforts. Parents who successfully negotiat ed these barriers and received EPSDT services encountered additional b arriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unrespon sive to their medical needs or interpersonally disrespectful. The impl ications for future outreach efforts and improving access to preventiv e health care services are discussed.