New research based on a survey commissioned by The Commonwealth Fund shows that an alarming portion of American men fail to get the medical care they need to stay in good health. A significant number of men do not get routine checkups, preventive care, or health counseling, and many ignore symptoms or delay seeking medical attention when sick or in pain. "This research dramatizes the need for expanded efforts to address men's special health needs," said Karen Davis, president of The Commonwealth Fund. "Change will require the combined efforts of physicians, health plans, and policymakers. Targeted educational programs can help promote preventive care and healthy behavior. Removing financial barriers is also vital. Without expanded access to affordable health coverage, many low-income men will not have the resources they need to take charge of their health." Out of Touch: American Men and the Health Care System presents a current picture of men's access to health care, experiences getting care, and health-related behaviors. The survey finds that many men lack regular contact with the health care system. Three times as many men as women had not seen a doctor in the previous year. One of three men had no regular doctor, compared with one of five women. Men's irregular connection to the health care system means they often go without preventive care. More than half of all men had not had a physical exam or a blood cholesterol test in the previous year. Among men age 50 or older, 60 percent had not been screened for colon cancer and 41 percent had not been tested for prostate cancer in the year prior to the survey. Even in the past five years, about one-third of men in this age group had not been tested for either disease—each a life-threatening condition that requires early detection for successful treatment. One of four men reported he would wait as long as possible before seeking help if he were concerned about his health, the survey showed. Nearly 40 percent would delay care a few days, and 17 percent would wait at least one week. Only 18 percent of men said they would seek care or medical advice as soon as possible. Even when they do visit the doctor, men are often too embarrassed to discuss health concerns with their physicians, the survey found. One of five men in the survey said that he was "not at all" or "not very" comfortable discussing health issues with a doctor. Among male patients who are at risk for coronary heart disease—the number-one killer of American men—a disturbingly low proportion said they had received health counseling from their physician. Less than two-thirds of smokers who went for an annual physical examination discussed smoking with their doctor. Even fewer of these men got counseling on exercise (43%) or diet and weight (37%). Lack of health insurance and gaps in coverage also contribute to men's infrequent contact with doctors, with low-income men the most affected. Three of five men living on incomes of $16,000 or less had been uninsured at some time during 1998. Among uninsured working-age men, 70 percent did not have a regular doctor, compared with 27 percent of men who were continuously insured throughout the year. Uninsured men were at least three times as likely as insured men not to have gotten care when needed, filled a prescription because of the cost, or seen a specialist. Race and ethnicity also play a role in men's health. Hispanics, for instance, were twice as likely as other men not to have seen a physician in the past year. Among men ages 18 to 64, one of three blacks was diagnosed with at least one of five chronic conditions, compared with one of four whites and one of five Hispanics. "Society's demand that men be strong and stoic can be harmful to their health if it causes them to ignore what their bodies are telling them and avoid seeking needed medical care," said David Sandman, program officer at The Commonwealth Fund and lead author of the study. "Men have a shorter life expectancy than women and suffer higher mortality rates from the leading causes of death. Strengthening men's connections to the health care system and sensitizing physicians to male health concerns could bring about improvements in men's longevity and well-being."