HOW ECONOMIC DEMAND INFLUENCES ACCESS TO MEDICAL-CARE FOR RURAL HISPANIC CHILDREN

OBJECTIVES. In a study of access to medical care, the authors analyzed the relationship between factors influencing demand, local unmet need s, and the availability of physicians in a rural California community. METHODS. The California Department of Health Services screened 1,697 (90%) of children aged 1 to 12 years in McFarland, CA. The relation of demand to unmet needs was examined using multiple logistic regression . Factors influencing demand for medical care were: ability to pay (in come, health insurance) desire to purchase care (ethnicity, education, perceived need), and incidental costs (transportation, child care, et c). Questions from the Hispanic Health and Nutrition Survey were recon strued to fit the demand model. Local need and demand for physicians w as compared with state levels to assess whether sufficient physicians were available. RESULTS. Eighty-six percent of the children were of Me xican ancestry. Factors influencing demand were linked with specific u nmet needs. Although unmet needs were high, demand was low; 46% of all families were below the poverty level. Although four primary care phy sicians were needed, only one could be supported in the private sector because of low demand. CONCLUSIONS. Advantages to the demand model ar e: (1) it shows why medical services are underused and lacking in low- income areas although need is high, (2) it permits an economic rationa le for extra services for poor diverse populations, (3) it estimates t he amount of resources lacking to assure adequate levels of care, (4) it shows why facilitated access is needed for certain groups.