Title: 2 Factors That Affect Health-Care Utilization | Health-Care Utilization as a Proxy in Disability Determination | The National Academies Press
Headings: 
2
Factors That Affect Health-Care Utilization
NEED FOR HEALTH-CARE SERVICES
ACCESS TO HEALTH CARE
Ability and Propensity to Use Services
Insurance and Ability to Pay for Services
DIFFERENCES IN HEALTH-CARE UTILIZATION ASSOCIATED WITH SELECTED CHARACTERISTICS
Race and Ethnicity
Sex
Working Age Adults
Spoken Language
Income and Poverty
Geography
Sociodemographic and Characteristics
Risk Factors
Utilization
Access
Geographic Practice Patterns
PEOPLE WITH DISABILITIES
SUMMARY AND CONCLUSIONS
REFERENCES

Content: and to have the need for services fulfilled. Access can be seen as a continuum: even if care is available, many factors can affect ease of access to it, for example, the availability of providers who will accept a person’s insurance (including Medicaid), ease in making an appointment with a given provider, the ability of a patient to pay for care (even if a patient is insured, due to cost-sharing copayments and deductibles), and the difficulty of arranging transportation to and from healthcare facilities ( AHRQ, 2010, MACPAC, 2016 ). Some of those issues are discussed below. Ability and Propensity to Use Services
People cannot access care if it does not exist in their geographic area, or if providers will not treat them because of insurance or other issues. Rural areas in particular have been identified as lacking a sufficient supply of specialty physicians and, in particular, mental health-care providers ( Meit et al., 2014; Douthit et al., 2015 ). Assuming that services are available, access to care might be impeded by other barriers