ABSTRACT
Rather than focus on generic issues pertinent to providing medical care for the poor, this chapter examines issues in the health care delivery system to two chronic conditions prevalent among the poor: hypertension and diabetes. There is no doubt that there have been significant advances in the clinical care of hypertensives and diabetics. Enabling factors are those that facilitate entry into the health care system and include insurance status, income, and geographic distance to the provider. Lack of access to primary care remains a problem for low-income individuals, as new kinds of evidence are demonstrating. Financial access to care, either through insurance or some other mechanism, is usually a prerequisite to treatment. The chapter reviews the most prevalent mechanisms by which financial access to care may be threatened: loss of insurance or source of care, cost sharing, capitation, and discrimination in insurance.
