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Allison L. Diamant, MD, MSHS, Ron D. Hays, PhD, Leo S. Morales, MD, PhD, Wesley Ford, MPH, Daphne Calmes, MD, MPH, Steven Asch, MD, MPH, Naihua Duan, PhD, Eve Fielder, DrPH, Sehyun Kim, PhD, Jonathan Fielding, MD, MPH, Gerald Sumner, PhD, Martin F. Shapiro, MD, PhD, David Hayes-Bautista, PhD and Lillian Gelberg, MD, MSPH

Allison L. Diamant, Ron D. Hays, Leo S. Morales, Martin F. Shapiro, and David Hayes-Bautista are with the UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, Calif. Allison L. Diamant is also with the UCLA National Center of Excellence in Women’s Health, Los Angeles. Ron D. Hays, Leo S. Morales, and Martin F. Shapiro are also with RAND Health, Santa Monica, Calif, as are Steven Asch and Naihua Duan. Steven Asch is also with the West Los Angeles Veteran’s Administration. Jonathan Fielding is with the Los Angeles County Department of Health Services. Daphne Calmes is with the Charles R. Drew University Department of Pediatrics, Los Angeles. Eve Fielder and Gerald Sumner are with the UCLA Institute for Social Sciences Research, Los Angeles. Sehyun Kim is with Pochon CHA University, Department of Preventive Medicine, Pochon, Korea. Lillian Gelberg is with the UCLA Department of Family Medicine, Los Angeles.

Correspondence: Requests for reprints should be sent to Allison L. Diamant, MD, MSHS, Assistant Professor, UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Ave, Los Angeles, CA 90095–1736 (e-mail: adiamant{at}mednet.ucla.edu).

Objectives. We estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system.

Methods. We conducted a stratified cross-sectional probability sample of primary care patients in the Los Angeles County Department of Health Services. Face-to-face interviews were conducted with 1819 adult patients in 6 languages. The response rate was 80%. The study sample was racially/ethnically diverse.

Results. Thirty-three percent reported delaying needed medical care during the preceding 12 months; 25% reported an unmet need for care because of competing priorities; and 46% had either delayed or gone without care.

Conclusions. Barriers to needed health care continue to exist among patients receiving care through a large safety net system. Competing priorities for basic necessities and lack of insurance contribute importantly to unmet health care needs.

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