United Way Study Shows Poor’s Health Needs Unmet

Orange County’s poor have “alarming” unmet health-care needs because they often lack insurance coverage and are stymied by other barriers to treatment, including language and transportation difficulties, according to a United Way report Tuesday.

Nearly three-fourths of the county’s poor have never been to a doctor for a regular checkup, and 41% of those with chronic illnesses such as diabetes, heart disease and asthma said they are not receiving treatment for those conditions, according to a survey of more than 700 residents.

Ethnicity as well as poverty is a factor in determining who gets treatment, according to the study, conducted by the United Way of Orange County Health Care Council in collaboration with UC Irvine physician Shiraz I. Mishra.

More than one in six said they had faced language barriers when seeking medical treatment. And a third of Latinos said they lacked a regular source of care, compared to 11% of whites.

Mishra presented the report Tuesday to the board of directors of OPTIMA, the organization charged with revamping services for the county’s 300,000 recipients of Medi-Cal, the government health insurance program for the poor. One OPTIMA board member, Dr. Peter Anderson, said that while the presentation was valuable, the report did not address all of the reasons why people do not seek basic medical treatment. By and large, he said, children in Orange County have access to pediatricians, and public health clinics offer free immunizations for youngsters under the age of 2.

Still, “we have a tremendous problem with the vaccination rate,” said Anderson, chief of emergency medicine at Fountain Valley Regional Hospital and Medical Center and president of the Orange County Medical Assn.

“The situation is not that we don’t have the access,” he said. “It’s just that parents don’t take their kids in.” That, he said, is a sociological problem that might not be entirely resolved “no matter what system we set up.”

The United Way survey suggests that poverty alone does not explain failure to vaccinate children. More than a sixth of poor children younger than 7 had never been immunized against diphtheria, tetanus, polio, measles, mumps and rubella. But a fifth of “non-poor” children in the same age range had never received measles, mumps or rubella shots either.

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The survey found, however, that poor people do not get many other preventive and primary care services as often as those with higher incomes.

The definition of “poor” was 125% or less of what the federal government defines as poverty-level income. For a family of four, that would be an annual income of $17,919 or less. Non-poor families were defined as those having incomes above $28,670.

More than a third of poor residents had not made an outpatient medical visit in the past year, compared to only 18% of non-poor residents. Among women 40 or older, more than twice as many poor as non-poor respondents had never had a mammogram.

Poor people were more likely than others to have to ride the bus or rely on a friend for transportation to medical appointments, the survey found, and to lack insurance coverage for prescription drugs and such services as mental health care and drug and alcohol treatment.

The report recommended that a community-based system be developed for poor and “nearly poor” people who have no regular source of health care. It should emphasize preventive services for children and adults, the report said, and should be publicized in English, Spanish and, if possible, some Asian languages. Translation, transportation and child-care services also were recommended for poor patients.

The survey, conducted with the help of Field Research Corp. of San Francisco, was based on telephone interviews conducted in English and Spanish with 718 Orange County residents. The margin of error was plus or minus 2%.

Results are to be presented to the County Board of Supervisors in January with a plan of action prepared by United Way.