Health Care Study Finds Millions at Risk in State : Survey: California leads nation in number who are uninsured, too poor to pay or lack access to physicians, advocacy group says.

Nearly 6.7 million people in California, more than in any other state, face the prospect of going without basic health care because they are too poor, are uninsured or lack access to physicians, according to a report released Wednesday by a community health advocacy group.

Nationally, the group estimated, 51 million people may be unable to obtain adequate care.

The study urged the nation to respond by developing and supporting community-based comprehensive health care.

The report was prepared for the National Assn. of Community Health Centers in Washington by Daniel R. Hawkins Jr., director of research and policy analysis at the association, and Sara Rosenbaum, senior staff research scientist at the Center for Health Policy Research at George Washington University here.

Hawkins and Rosenbaum, who developed their figures by extrapolating from government and other demographic data collected in 1990, estimated that one in five Americans is at risk of going without basic care and one in six is underserved--that is, actually lacked access to primary health services.

At-risk individuals were defined as those whose incomes are significantly below the federal poverty level and who are either uninsured or dependent on Medicaid. Low-income elderly people covered only by Medicare also are considered at risk. Underserved individuals were said to be those living in counties already found to have inadequate medical services in general or an inadequate supply of primary-care physicians.

The 48-page study cited California as one of six states in which more than a fifth of the population faces the possibility of receiving inadequate care.

Specifically, it found that 6,683,019 Californians risk limited access or no access at all to health care. The state’s population is 29,760,021.

In Los Angeles County, where 8.9 million people live, an estimated 2.1 million are unable to get basic health care, more than in any other county in the state, the report estimated. In Orange County, where 2.4 million people live, about 357,600 people are deprived of basic care.

The report, “Lives in the Balance: A National, State and County Profile of America’s Medically Underserved,” said that national health care reforms, such as recent White House proposals for affordable insurance, are “an urgent need.”

But it said that health insurance is of little benefit to sick people unless medical centers are easily accessible in their communities.

The report called on national health policy-makers to provide “real access to comprehensive primary and preventive health services,” regardless of place of residence or income.

“Medical underservice most frequently stems from the fact that in thousands of communities across the nation, services are not actually accessible to the residents who need them most,” the report said. “Because so much medical underservice in the U.S. occurs in counties with a seemingly sufficient supply of physicians, this study makes clear that simply insuring everyone of medical care and even increasing the supply of physicians will not cure the problem.”

Based on its formulas, the study estimated that residents in 70%, or 2,147, of U.S. counties are medically underserved.

In addition, the report said:

* Persons at risk for medical underservice span all ages and live in all parts of the country, including 14 million children under age 18 and 6 million children under age 6.

* More than 9 million of those at risk are women of child-bearing age, between 18 and 44. And 10.1 million are elderly or disabled Medicare beneficiaries.

* About four of every five at-risk persons (33.5 million) live in urban areas.

* The lopsided majority (40.5 million of 42.8 million at-risk of medical underservice) have inadequate access to health care because they cannot afford it, not because of a shortage of doctors in their communities.