Impact of the Mammography Quality Standards Act on access in Minnesota.

OBJECTIVES: The Minnesota Department of Health surveyed registered mammography facilities to assess their accreditation status prior to full implementation of the Federal Mammography Quality Standards Act (MQSA), which mandated accreditation of all mammography facilities by October 1994; to strategize on the steps that might be taken to avoid closure of facilities; and to evaluate the ultimate impact of the law on the availability of mammography in Minnesota. METHODS: Mammography facilities registered with the Radiation Control Section of the state health department were surveyed five months prior to and four months after the October 1994 deadline. Data collected included accreditation status, plans for continuing service, number of mammograms performed, and areas in which technical assistance was needed. In October 1995, the number and distribution of facilities were determined from the Radiation Control Section registration database. RESULTS: The pre-MQSA survey of 182 respondents found that 96% planned to continue mammography services but only 49% were accredited. The remaining 51% had applications in progress. In the post-MQSA survey, 70% of 182 facilities were found to be accredited, and 30% were operating under provisional certification. As of October 1995, although six facilities had closed, there was a net gain of four mammography facilities providing on-site service. CONCLUSIONS: Despite fears to the contrary, access to mammography in the state of Minnesota was not adversely affected by full implementation of the Mammography Quality Standards Act.

How economic demand influences access to medical care for rural Hispanic children.

OBJECTIVES: In a study of access to medical care, the authors analyzed the relationship between factors influencing demand, local unmet needs, and the availability of physicians in a rural California community. METHODS: The California Department of Health Services screened 1,697 (90%) of children aged 1 to 12 years in McFarland, CA. The relation of demand to unmet needs was examined using multiple logistic regression. Factors influencing demand for medical care were: ability to pay (income, health insurance) desire to purchase care (ethnicity, education, perceived need), and incidental costs (transportation, child care, etc). Questions from the Hispanic Health and Nutrition Survey were reconstrued to fit the demand model. Local need and demand for physicians was compared with state levels to assess whether sufficient physicians were available. RESULTS: Eighty-six percent of the children were of Mexican ancestry. Factors influencing demand were linked with specific unmet needs. Although unmet needs were high, demand was low; 46% of all families were below the poverty level. Although four primary care physicians were needed, only one could be supported in the private sector because of low demand. CONCLUSIONS: Advantages to the demand model are: (1) it shows why medical services are underused and lacking in low-income areas although need is high, (2) it permits an economic rationale for extra services for poor diverse populations, (3) it estimates the amount of resources lacking to assure adequate levels of care, (4) it shows why facilitated access is needed for certain groups.