From: barbara_a._haley@hud.gov
Message-Id: <9802268885.AA888502796@hudsmtphq.hud.gov>
Date: Thu, 26 Feb 98 09:24:49 -0500
To: <MedSoc@csf.colorado.edu>
Subject: Re: Request for comments
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          Hi!

          re: barriers to health care services

          In addition to "perceived barriers" to health care
          services, don't miss taking a look at ACTUAL barriers,
          which can be considerable for a person with (a) no health
          insurance and (b) who has a stigmatized occupation.  There
          is also a locational effect.  For example, in Alabama there
          are basically two cities where the uninsured can get into
          a public emergency room without too many hassles (other
          than a very long wait).  People in other locations have to
          drive long distances or put themselves at the mercy of the
          local providers.  (Of course, if the triage nurse does not
          deem your case an "emergency" you can't even get into the
          public hospitals without a hefty down payment and/or proof
          of insurance.)

          In addition, there is a great deal of variation in outreach
          to sex workers by public health departments, so be sure to
          build this into your design.

          For a run down of the journal literature on access to care,
          see my recent book: American Health Care in Transition: A
          Guide to the Literature.  Published by Greenwood Press.


          Barbara Haley
          (202) 755-1805 ext. 126