Year of Publication



Martin School of Public Policy and Administration

Executive Summary

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

  • Does mental illness predict greater difficulties with access to health care?


The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate analysis using STATA version 9 was used to model the relationship between the access index as a function of mental illness, controlling for demographics, insurance, health, education, income, geographic region and education variables. Due to the low response rate for earnings in the sample, two regression models were used, one that included earnings and one that did not.


Health care access was significantly greater for respondents who reported a mental illness diagnosis than those who did not report a mental illness diagnosis in both models. Omitting earnings from the regression model changed the significance for some variables. In the model without earnings, health care access was significantly greater for African-Americans than the other racial groups, while access problems were significantly greater for Caucasians in the model that included earnings. Hispanics showed significantly less access problems than Caucasians in both models, which is contradictory to available data. Education and age were also affected by earnings. Those with less than a high school education had significantly greater access problems than those with more than a high school education in the model that excluded earnings, while those with more than high school had significantly greater access problems than high school graduates. Access problems were significantly less as age increased in the model without earnings, but age was insignificant in the model with earnings included. The West region had significantly greater access problems than did the other three regions in both models. Descriptive statistics showed that respondents who reported a mental illness diagnosis were more likely to be female, have some type of government insurance or no insurance, earn less income, have less education and have greater access problems across all nine access measures.


  • The contradictions found in this study compared to data presented in the literature for health care access among Hispanics should be explored. Citizenship status, language issues and clinics/offices Hispanics utilize for health care could be examined in order to find more information about the factors that affect access.

  • Regional differences that contradict data in the literature should be examined. Changes in the demographics of the population in a particular region may be a factor.

  • Earnings as a factor in access should be further explored to determine its impact upon those with mental illness. The low response rate to the question impacted the results of the regression analysis as it limited the number of observations.

  • Given the small r^2 value, research is needed to evaluate other factors that might affect health care access for people with mental illness.