Survey Shows Gaps in Care for Women on Medicaid : Health: Patients often rely on hospital emergency rooms when they become ill, and fail to get routine tests. Lack of child care and transportation called obstacles.

Many women on Medicaid rely on hospital emergency rooms when they become ill and fail to receive routine tests--such as Pap smears and breast examinations--that can detect life-threatening diseases, according to a survey of female Medicaid recipients released Friday.

Eighty percent of those polled gave high marks to the quality of care provided by the Medicaid system, known as Medi-Cal in California, and to their personal physicians.

But many women also lamented gaps in coverage and cited obstacles, such as the unavailability of child care or transportation, that prevent them from seeking prompt treatment when they get sick.

“We have to start taking a look at these external barriers that prevent women from getting quick access to health care,” said Joan Kuriansky of the Campaign for Women’s Health, a coalition of 70 national groups that commissioned the survey.

“Without immediate care, women become sicker, lose days at work and expose their children to illnesses.”

Medicaid, jointly funded and administered by the states and the federal government, is the program through which most low-income people in the United States obtain medical care. In California, Medi-Cal serves more than 5 million people.

In recent years, Medicaid has been the object of rancorous debate, mostly over issues of eligibility and the dwindling number of doctors and hospitals willing to treat patients under the program.

The survey, unveiled Friday at an American Medical Assn. conference in San Francisco, addressed a different question: How well is Medicaid meeting the health care needs of those it serves?

Between Jan. 25 and Feb. 8, 1,300 women in four states--California, Michigan, Georgia and Arkansas--were interviewed. The broad conclusion was that Medicaid functions as a system “set up for episodic, acute care rather than long-term, preventive care.” The consequences take a toll both on women’s health and on the financial solvency of the Medicaid system, the study’s authors said.

Among the key findings:

* More than one-third of the women polled said they find it easier to use an emergency room than to visit a doctor’s office when they are ill.

* Forty percent of the women surveyed had only two of five simple screening tests--for high blood pressure, diabetes, cholesterol, and cervical and breast cancer--in the last year.

* One in four women reported that a pharmacist has refused to fill a prescription because it is not covered under Medicaid. The number of drugs on Medicaid’s reimbursement list is shrinking and many states require prior approval for certain prescribed drugs.

* One-third of those polled said child-care and transportation troubles keep them from seeing a doctor immediately when they become sick, even though their symptoms are serious enough to warrant a visit.

“Child care is a major, major problem,” said Lynn Kersey, who helps pregnant women on Medi-Cal as part of her work at the Children’s Advocacy Institute in Los Angeles. “People are told not to bring their kids, they’re made to feel unwelcome. So they don’t go back.”

Several physicians at a press briefing on the study said the results generally confirm their anecdotal experience. They added that the study provides a useful assessment of Medicaid’s performance at a time when the Clinton Administration is attempting to reform the nation’s health care system.