Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #162 

February 2007 

Getting Health Care from Specialists 

among Adults with Chronic Conditions, 

U.S. Civilian Noninstitutionalized 

Population, 2004 

Highlights 

 In 2004, half (50.0 percent) of 

the U.S. civilian noninstitutionalized adult population who had 

chronic conditions reported 

they or a doctor thought they

needed to see a specialist in 

the past 12 months. 

 Among adults with chronic 

conditions who reported they

needed to see a specialist, 7.8 

percent reported it was a big 

problem to see a specialist and 

17.1 percent reported it was a 

small problem.

 Among adults with chronic 

conditions who reported they

needed to see a specialist, 

younger adults were more likely

to report it was a big problem to 

see a specialist than elderly

adults. 

 Among adults with chronic 

conditions who reported they

needed to see a specialist, 

non-Hispanic blacks and 

Hispanics were more likely 

than non-Hispanic whites to 

report it was a big problem to

see a specialist.

 Among nonelderly adults with

chronic conditions who reported 

they needed to see a specialist, 

32.8 percent of the uninsured

reported it was a big problem to 

see a specialist compared with

7.0 percent of privately insured 

and 18.5 percent of publicly

insured nonelderly adults with 

chronic conditions.

Anita Soni, PhD and Steven C. Hill, PhD 

Introduction 

Specialists are doctors who have completed advanced education 

and clinical training in a specific medical or surgical field. In 2004, 

more than half of the physicians in the United States were 

specialists, such as allergists, cardiologists, dermatologists,

neurologists, oncologists, and surgeons (U.S. Census Bureau

2007). Most adults need specialty care at some time in their lives. 

Many adults with chronic conditions, such as ischemic heart disease 

or diabetes, need to see specialists more frequently than healthier 

adults. Persons with chronic conditions often need physicians with 

specialized knowledge and expertise in monitoring and treating their 

specific conditions (Wagner et al. 2001). Patients with complications 

or severe or persistent symptoms particularly need to see 

specialists (Katon et al. 2001). The ease with which adults with 

chronic conditions are able to obtain specialist care when needed is 

one indication of the accessibility of health care for those with 

greater needs (Beatty et al. 2003; Schoen et al. 2005). 

Using data from the Household Component of the Medical 

Expenditure Panel Survey (MEPS-HC), this Statistical Brief 

presents estimates on the perceptions of adults with and without 

chronic conditions about their need for and access to physician 

specialists in 2004. The estimates are the opinions of the adult U.S. 

civilian noninstitutionalized population regarding their need to see 

specialists and how much of a problem it was to see a specialist. All 

comparisons discussed in the text are statistically significant at the 

.05 level unless otherwise noted. 

Findings 

In 2004, approximately 90 million adults had been told by a doctor that 

they had one or more specific chronic conditions (see Definitions section). Among those adults who had 

these chronic conditions, about half (50.0 percent) reported they or a doctor thought they needed to see a 

specialist (figure 1). In contrast, only about one-fourth (24.0 percent) of those who did not have chronic 

conditions perceived a need to see a specialist. 
Among adults with chronic conditions who reported they needed to see a specialist, 7.8 percent reported

it was a big problem to see a specialist. In this population, 17.1 percent reported it was a small problem to

see a specialist as compared with 19.8 of those without chronic conditions (figure 2). Among adults with 

chronic conditions, 72.3 percent reported that seeing a specialist was not a problem at all as compared

with 69.2 percent of those without chronic conditions. 

Age 

Age is strongly correlated with perceived need to see a specialist. Among those with chronic conditions, 

more than half (56.2 percent) of elderly adults (65+) needed to see a specialist (figure 3). In comparison, 

just over one-third (37.6 percent) of those in the 18–44 age group needed to see a specialist. 

Among adults with chronic conditions who thought they needed to see a specialist, a higher percentage of 

nonelderly adults (18–44) reported it was a big problem to see a specialist than those in older age groups 

(45–64 or 65+) (15.3 percent versus 8.4 percent and 3.5 percent). 

Race/ethnicity

Among adults with chronic conditions, a higher percentage of non-Hispanic whites reported they or a 

doctor thought they needed to see a specialist (52.8 percent) as compared with Hispanics and nonHispanic blacks (44.7 percent and 37.4 percent) (figure 4). Among adults with chronic conditions who 

needed to see a specialist, a greater percentage of Hispanics and non-Hispanic blacks reported it was a 

big problem to see a specialist as compared with non-Hispanic whites (12.2 percent and 12.0 percent 

versus 6.4 percent). 

Insurance status 

Among nonelderly adults with chronic conditions, a smaller percentage of uninsured adults reported that 

they or a doctor thought they needed to see a specialist as compared with the adults with private 

insurance or public insurance (29.6 percent versus 48.8 percent and 50.2 percent) (figure 5). Despite the 

lower need for specialist care among the uninsured with chronic conditions, a much higher percentage 

reported it was a big problem to see a specialist. Among nonelderly adults with chronic conditions who 

needed to see a specialist, 32.8 percent of the uninsured reported it was a big problem compared with 7.0 

percent of privately insured and 18.5 percent of publicly insured nonelderly adults with chronic conditions. 

Among elderly adults, a higher percentage of adults who had Medicare and private insurance reported a 

perceived need to see a specialist as compared with those who had Medicare only or who had Medicare 

and additional public insurance (58.8 percent versus 52.9 percent and 51.6 percent). Among elderly 

adults with chronic conditions who needed to see a specialist, the percentage who thought it was a big 

problem did not differ significantly based on their insurance status. 

Data Source

The estimates shown in this Statistical Brief are drawn from analyses conducted by the MEPS staff on the 

2004 Full Year Consolidated Data public use file (HC-089). 

Definitions 

Chronic conditions 

The indicator for chronic conditions was drawn from variables indicating presence of the following chronic 

conditions: arthritis, active asthma, diabetes, emphysema, high blood pressure, ischemic heart disease 

(coronary heart disease, angina, heart attack, or any other heart related disease), and stroke. For each of 

the conditions listed, the following question was asked: “(Have/Has) PERSON ever been told by a doctor 

or other health professional that PERSON had [condition].” For asthma, those with an affirmative answer 

were further asked: “(Do/Does) (PERSON) still have asthma?” In this Statistical Brief, only those with 

active asthma (those who answered affirmatively to the follow-up question) are included among those 

with chronic conditions. 

Needing specialist care and access to specialists 

Questions about adults’ need for and access to specialists are asked annually in the MEPS adult selfadministered questionnaire. These questions were taken from health plan version 3.0 of CAHPS®, an 

 
AHRQ-sponsored family of survey instruments designed to measure experiences with care from the 

consumer’s perspective. The questions ask: 

Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and others who 

specialize in one area of health care. In the last 12 months, did you or a doctor think you needed to 

see a specialist? 

If yes: In the last 12 months, how much of a problem, if any, was it to see a specialist that you needed 

to see? A big problem, A small problem, Not a problem. 

More information about CAHPS® can be obtained through the CAHPS® Web site (www.cahps.ahrq.gov). 

Racial and ethnic classifications 

Classification by race and ethnicity is based on information reported for each family member.

Respondents were asked if each family member’s race was best described as American Indian, Alaska 

Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member’s 

main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or 

Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was 

reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. 

Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders 

Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other 

do not include Hispanic. MEPS respondents who reported other single or multiple races and were nonHispanic were included in the other category. 

Health insurance status 

Individuals under age 65 were classified in the following three insurance categories based on household 

responses to health insurance status questions: 

– Any private health insurance: Individuals who, at any time during the year, had insurance that provides

coverage for hospital and physician care (other than Medicare, Medicaid, or other public

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that

provides coverage for a single service only, such as dental or vision coverage, was not included. 

– Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, and 2) 

they were covered by one of the following public programs at any point during the year: Medicare, 

Medicaid, or other public hospital/physician coverage. 

– Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the 

entire year or period of eligibility for the survey. 

For individuals 65 and older, the following insurance categories were used: 

– Medicare only: Individuals who, at any time during the year, were covered by Medicare only. For 

analytic purposes, this classification also includes a very small number of persons ages 65 and over 

who did not report Medicare coverage. 

– Medicare plus private (including TRICARE): Individuals who at any time during the year, were covered 

by a combination of Medicare, TRICARE or private insurance. 

– Medicare plus other public coverage: Individuals who, at any time during the year, were covered by 

Medicare in addition to some other type of public insurance. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

 
References

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

For more information about specialists and care for people with chronic conditions, see the following 

publications: 

Beatty, P. W., K. J. Hagglund, M. T. Neri, K. R. Dhont, M. J. Clark, and S. A. Hilton. Access to health care 

services among people with chronic or disabling conditions: patterns and predictors. Archives of Physical 

Medicine and Rehabilitation, October 2003, 84(10):1417–25. 

Katon, W., M. Von Korff, E. Lin, and G. Simon. Rethinking practitioner roles in chronic illness: the 

specialist, primary care physician, and the practice nurse. General Hospital Psychiatry, May-June 2001, 

23(3): 138–144 

Schoen, C., R. Osborn, P. H. Huynh, M. Doty, K. Zapert; J. Peugh, and K. Davis. Taking the pulse of 

health care systems: experiences of patients with health problems in six countries. Health Affairs, JulyDecember 2005, Supplement Web Exclusives:W5-509-25. 

U.S. Census Bureau. Statistical Abstract of the United States: 2007. (126th Edition) Washington, DC, 

2005. 

Wagner, E. H., B. T. Austin, C. Davis, M. Hindmarsh, J. Schaefer, and A. Bonomi. Improving chronic 

illness care: translating evidence into action. Health Affairs, November-December 2001, 20(6):64–78. 

Suggested Citation 

Soni, A. and Hill, S. C. Getting Health Care from Specialists among Adults with Chronic Conditions, U.S. 

Civilian Noninstitutionalized Population, 2004. Statistical Brief #162. February 2007. Agency for 

Healthcare Research and Quality, Rockville, Md. http://www.meps.ahrq.gov/mepsweb/data_files/ 

publications/st162/stat162.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road

Rockville, MD 20850 

 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2004.

24.0

50.0

0

15

30

45

60

With chronic conditions Without chronic conditions

Percent

Figure 1. Percentage of adults with and without

chronic conditions who needed to see a specialist, 2004

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2004.

Figure 2. Among adults with and without

chronic conditions who needed to see a specialist,

level of the problem in seeing the specialist, 2004

Big problem Small problem No problem Not ascertained

Adults with chronic conditions

17.1%

72.3%

2.8% 7.8%

Adults without chronic conditions

19.8%

69.2%

2.2% 8.8%

Statistical Brief #162: Getting Health Care from Specialists among Adults with Chronic Conditions, U.S. Civilian Noninstitutionalized 

Population, 2004
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2004.

3.5

15.3

37.6

51.9

8.4

56.2

0

15

30

45

60

Needed to see specilaist Big problem*

18-44 45-64 65+

Percent

Figure 3. Percentage of adults with

chronic conditions who needed to see a specialist 

and thought it was a big problem, by age, 2004

*Among those who needed to see a specialist.

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2004.

6.4

44.2

12.2

44.7

37.4

12.0

52.8

17.7

0

15

30

45

60

Needed to see specialist Big problem*

Hispanic Non-Hispanic black Non-Hispanic white Other

Percent

Figure 4. Percentage of adults with chronic 

conditions who needed to see a specialist and 

thought it was a big problem, by race/ethnicity, 2004

*Among those who needed to see a specialist.

Statistical Brief #162: Getting Health Care from Specialists among Adults with Chronic Conditions, U.S. Civilian Noninstitutionalized 

Population, 2004
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2004.

Private Public Uninsured

Percent

Figure 5. Percentage of adults with chronic 

conditions who needed to see a specialist and thought 

it was a big problem, by age and insurance status, 2004

65+

5.9

52.9

4.5 2.7

58.8

51.6

0

10

20

30

40

50

60

70

Needed to see specialist Big problem*

Medicare only Medicare+Private Medicare+Public

18-64

32.8

48.8

7.0

18.5

50.2

29.6

0

10

20

30

40

50

60

Needed to see specialist Big problem*

*Among those who needed to see a specialist.

Statistical Brief #162: Getting Health Care from Specialists among Adults with Chronic Conditions, U.S. Civilian Noninstitutionalized 

Population, 2004