Indigent Health Care Lacking, UCI Study Says

Too many of Orange County’s poor lack medical insurance, are unable to get their children vaccinated and rarely see a doctor, UC Irvine researchers reported in an article published Tuesday in the American Journal of Medicine.

“I think that the indigent care system in Orange County is in a crisis,” said F. Allan Hubbell, an internist and principal author of the article, which was based on a health-care survey of northern Orange County residents.

“This study has pointed out in a scientific way the problems of access that exist in Orange County,” he said in an interview Tuesday. “One of the most disturbing findings in my mind was the fact that these types of problems could occur in one of the more affluent areas of the country. I hate to think what may be going on in areas that aren’t affluent.”

In analyzing the results, UCI researchers found that 28% of the adults and 18% of the children surveyed had no doctor, hospital or clinic that could be called their regular source of medical care. And 37% of the poor residents surveyed lacked health insurance.

Cites National Dilemma

While the article focuses on problems of the poor in northern Orange County, it also highlights a growing national dilemma over access to health care and health insurance, Hubbell and his three co-authors wrote.

For while legislators debate the merits of national health insurance, “millions of Americans are going without medical care,” the UCI researchers said.

Even in affluent Orange County, they noted, where the median income is about $44,000 a year, 17% of residents live in households below the national poverty level and county officials “spend less per capita for indigent care than all but two of the state’s 58 counties.”

The study comes at time when three Orange County hospitals recently have dropped out of the Medi-Cal system and health care officials worry that there are fewer places for the poor to get care. UCI Medical Center in Orange, the county’s largest provider of health care for the poor, has also threatened to drop out of Medi-Cal.

In the UCI survey, conducted initially at the request of St. Jude Hospital in Fullerton, English and Spanish-speaking interviewers polled 652 adults and their families living in Fullerton, Brea, Placentia and east Anaheim.

The report said that more than half the adults and children surveyed had not seen a dentist in the past year, and 5% of the children have never been immunized against polio, diphtheria, whooping cough or tetanus. Further, 23% of women with young children had not received prenatal care in the first trimester of their pregnancy.

Those surveyed did not receive regular medical care because of “lack of health insurance, inadequate financial resources, outstanding medical bills, lack of citizenship documentation and inconvenient physician office hours,” the report said.

It also concluded that Latinos were much less likely than Anglos to have a regular source of health care. Some 31% of Latinos surveyed did not have a doctor, compared to 17% of Anglos, the study found.

A comparable national survey by the Robert Wood Johnson Foundation in 1986 found that 22% of the poor lacked health insurance. The difference in these results can be explained by greater numbers of undocumented aliens in Orange County, composing 17% of the county’s poor, the UCI report said.

Still, Hubbell said he considered the statistics on health insurance particularly significant. They showed, “If you had health insurance, you were three times more likely to have a regular source of care than if you weren’t insured.”

Although the telephone survey was conducted more than a year ago--from October, 1987, to January, 1988--Hubbell said he believes the findings remain valid today. If anything, he said, “I would guess that things are worse than they were.”

Thomas F. Riley, chairman of the Orange County Board of Supervisors, said he had received an advance copy of the medical journal article and had directed his health-agency staff to see what the county could do. But he said the problems are complex.

“If we could wave a wand and do something up here, it would be great,” Riley said, adding that he is angry about the limits placed on county health-care spending because of inadequate state funding.

Health Care Agency director Tom Uram said the study “verifies some things we suspect and maybe some action will come forward” to improve low-income residents’ with access to health care.

Dr. Rex Ehling, the county’s public health officer, said he had not seen a copy of the report but, when told of some of its findings, he said he was not overly concerned. He suggested that an immunization rate for low-income children of 5% was “not bad.” The danger from that rate was more of a danger to the individual who was not immunized than to the general public, he added.

Although the UCI study cited a litany of troubles for the poor, it ended with a remedy.

As a result of the researchers’ recommendations, St. Jude has leased a van that offers health screenings and immunizations to children. It also hired a health educator who speaks at local churches and it has opened a dental clinic in La Habra.

Hubbell’s report suggested that similar “community-oriented programs” to address the health needs of the poor would be appropriate in communities beyond Orange County.

Co-authors of the UCI study were internist Howard Waitzkin, Dr. Shiraz I. Mishra, who is a graduate student in social ecology, and social ecology Prof. John Dombrink.

MEDICAL CARE SURVEY RESULTS In north Orange County, 652 low-income adults and 231 children were asked about their access to medical care. The percentages listed here are of valid responses.

Adults Children No regular source of care 28% 18% No physician visit in the prior year 17% 15% No physical examination in prior year 48% 41% No Pap smear in prior year (women) 54% ---- No dental examination in prior year 52% 51% No prenatal care in first trimester* 23% ---- Never immunized (children under 17) Diphtheria, pertussis, tetanus (DPT) ---- 5% Polio ---- 5% Measles ---- 9%

* (women with children under 4 years old)

Source: American Journal of Medicine