Objectives of the 2001 CHAP were to determine the extent of medical care problems in the community, including:

The 2001 CHAP includes the analysis of the 1998 and 1999 Behavioral Risk Surveillance System (BRFSS) data for Sedgwick County and the results of a telephone survey of the general population of Sedgwick County.  The 2001 CHAP is narrower in scope than the 1997 CHAP, none-the-less, it provides a snap shot of access to care issues, and the health of Sedgwick County residents.

Access to health care has become a national priority as evidenced by the Healthy People 2010 Objectives.  New governmental and private foundation funding streams target access to care.  The Kansas Legislature has initiated activity involving access to care issues for the state’s uninsured population.  Likewise, Healthy People 2010 Objective 1-1 advocates an increase in the proportion of persons with health insurance from a baseline of 86% in 1997 to 100% in 2010.  Likewise, Objective 1-4a advocates an increase in the proportion of persons who have a specific source of ongoing care.  Health insurance provides access to health care.  Persons with health insurance are more likely to have a primary care provider and to receive preventive care. 

Primary care is defined as one’s regular source of care characterized by continuity, comprehensiveness, coordination, availability and convenience (Stewart et al, 1997; Donaldson, 1996; Blumenthal, 1995; Starfield, 1992; Aday et al, 1984).  Increased continuity and comprehensiveness of care, has been found to be associated with greater use of preventive services, higher compliance with appointment keeping, improved use of medications and better health outcomes (Carcillo et al, 1995; Benson et al, 1984; Charney et al, 1967). 

Risk factors for under use of primary care include minority status (Wagner & Guendelman, 2000; Hellinger 1995, Wood et al, 1995; Walcott-McQuigg et al, 1994; Blendon et al, 1989; Newacheck et al, 1988; Woolhandler et al, 1988; Hough et al, 1987; Wells et al, 1987), low income (Hueston & Hubbard, 2000), cost of care (Elnicki et al, 1995), and not having health insurance (Stewart et al, 1997; Idler & Angel, 1990; Freeman et al, 1987; Mossey & Shapiro, 1982).  Younger age is a risk factor for nonurgent ED use among low income uninsured. (MacLean et al, 1999; Ziv et al, 1998; Halfon et al, 1996, Mayefsky et al 1991). 

Growth in the number of uninsured Americans is now estimated at 44 million nationally (Shirk et al, 2000).  Current estimates of the total number of uninsured in Wichita/Sedgwick County range from 40,000 to 60,000 (Fonner, Dismuke & Wetta-Hall, 2000).  Lack of a comprehensive health care system in the United States has resulted in increased pressure on hospitals to provide care under an ever-widening variety of nonurgent conditions (Cross, 1992).  Studies have shown that a lack of a regular source of care is associated with increased reliance on ED services (Lambrew et al (1996); Baker, Stevens & Brook, 1994; Grumback et al, 1993).  When a patient seeks chronic, non-urgent treatment in an ED, the care lacks continuity.  Providing such non urgent ED services also adds unnecessary costs to the health care system because for each primary care patient presenting in the ED--the staff must start over, taking a medical history, performing a physical exam, and ordering lab tests (Friedman et al, 1992). Follow-up visits, which are routine in primary care settings, are non-existent in EDs.  In addition, ED care is expensive and the least cost-effective method of delivering health care to the uninsured. 

This background shaped the 2001 CHAP Telephone Survey, which elicits information about health insurance coverage and medical care access among Sedgwick County households.  The survey collected information not only about the respondent, but also obtained data about their dependents and other adults who reside in their household.  Several informational areas were investigated, including demographic characteristics of survey respondents, the type and costs of health care insurance coverage, where their coverage is purchased, and reasons for not being insured.  Secondly, the survey assessed medical care seeking behaviors, such as frequency, location, type of services, costs associated with medical care services, and perceptions about barriers to health care services.