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Annette L. Fitzpatrick, PhD, MA, Neil R. Powe, MD, MPH, MBA, Lawton S. Cooper, MD, MPH, Diane G. Ives, MPH and John A. Robbins, MD

Annette L. Fitzpatrick is with the Department of Epidemiology, University of Washington, Seattle, Wash. Neil R. Powe is with the Department of Epidemiology, Department of Medicine, and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Md. Lawton S. Cooper is with the Prevention Studies Research Group, National Heart, Lung, and Blood Institute, National Institutes of Health, Division of Epidemiology and Clinical Applications, Bethesda, Md. Diane G. Ives is with the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa. John A. Robbins is with the Department of Internal Medicine, University of California–Davis, Sacramento, Calif.

Correspondence: Requests for reprints should be sent to Erika Enright, CHS Coordinating Center, Building 29, Suite 310, University of Washington, 6200 NE 74th Street, Seattle, WA 98115 (e-mail: eenright{at}u.washington.edu).

Objectives. We evaluated self-perceived access to health care in a cohort of Medicare beneficiaries.

Methods. We identified patterns of use and barriers to health care from self-administered questionnaires collected during the 1993–1994 annual examination of the Cardiovascular Health Study.

Results. The questionnaires were completed by 4889 (91.1%) participants, with a mean age of 76.0 years. The most common barriers to seeing a physician were the doctor’s lack of responsiveness to patient concerns, medical bills, transportation, and street safety. Low income, no supplemental insurance, older age, and female gender were independently related to perceptions of barriers. Race was not significant after adjustment for other factors.

Conclusions. Psychological and physical barriers affect access to care among the elderly; these may be influenced by poverty more than by race.

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