Demonstrating Lack of Child Care as a Barrier to Health Care for Women in Parkland Health & Hospital System [04H

Abstract

INTRODUCTION: Women face significant barriers to care related to their roles as caretakers; in a prior survey, up to 20% report foregoing care because of difficulties with child care. We describe how lack of child care impacts access to health care and determine patient interest in a hospital-based day care center. METHODS: This is a non-regulated cross-sectional survey of 300 women of reproductive age attending Parkland Health & Hospital System (PHHS) clinics. Outpatient clinics sampled included: Primary Care, Obstetrics & Gynecology, Oncology. RESULTS: Response rate was 96.7% with 52.7% reporting foregoing health care for lack of child care in the past 12 months. On average, women delayed 3.7 ± 2.7 appointments/year. 38.2% delayed care for 1 to 6 months and 30.9% for 1 week to 1 month. 86.8% missed checkups, and 31.8% missed problem visits. Lack of child care (52.7%) was the most frequently cited reason for missing care followed by lack of transportation (32.8%) and insurance (25.2%). There was an association between race/ethnicity and whether women delayed care in the past 12 months with 68.8% white, 55.0% black, and 34.3% Hispanic (P=.001). 87.9% felt a hospital-based day care would help them attend visits. CONCLUSION: Our study demonstrates that child care is the most significant barrier to accessing health care, affecting women of all races/ethnicities in our county-supported safety net system. A hospital-based day care center may help alleviate this barrier, and our goal is to study outcomes after the introduction of such a center at PHHS in 2020.