THURSDAY, July 7 (HealthDay News) — Costs are getting in the way of women’s health care, with about a quarter of American women not getting the care they need, a new national report finds.

While most women surveyed are in good health and satisfied with the care they get, a sizable minority cannot afford such basics as seeing a doctor or filling a prescription. The problem is particularly pronounced among women without health insurance and women in failing health.

“Health-care cost is an important women’s issue,” said report author Alina Salganicoff, vice president and director of women’s health policy at the Kaiser Family Foundation. “There’s an increasing impact of cost, even among women with insurance coverage.”

“The bottom line is as long as health care is a purchasable commodity, women will not be getting the care they need,” added Dr. Eileen Hoffman, a clinical associate professor of medicine at New York University School of Medicine in New York City. Hoffman was involved in a Kaiser report on women’s health that was done in the 90s.

The latest survey was released by the Kaiser Family Foundation Thursday.

The foundation conducted its first survey of women and health in 2001. The current survey, conducted in 2004, is an expanded version of that initial project, and is based on interviews with 2,766 women aged 18 and older.

The status of women in the health-care system can, in some ways, be seen as a barometer for the overall system. “The major users of the health-care system are women,” Hoffman pointed out. “Women make up the bulk of people with chronic diseases, and the bulk of people with depression. They’re also the bulk of people who get prescriptions written to them. Poor quality, poor service, high cost is bound to be a higher burden on women than on men.”

More women today are foregoing needed health care, the survey found. In 2004, 27 percent of non-elderly women and 67 percent of uninsured women said they delayed or went without care they believed they needed because of prohibitive costs, compared with 24 percent and 59 percent in 2001.

“One of the issues with the uninsured is that in many cases they delay care and their health situation really becomes much worse, and more costly for the system and for them to absorb,” Salganicoff said.

The numbers were lower but still striking among women with private insurance: 17 percent delayed or went without care in 2004. Also, 20 percent of women said they did not fill a prescription during the past year because they could not afford it, while 14 percent reported skipping or taking smaller doses of a medication to make them last longer.

And even when women do get health care, there seem to be shortfalls, especially in the area of preventive medicine.

Only 33 percent of women said they had talked to a health-care professional in the past three years about smoking, 20 percent about alcohol use, 43 percent about calcium intake and 55 percent about diet, exercise and nutrition.

Among women of reproductive age, only 31 percent said they have talked with their doctor about their sexual history. Only 28 percent had talked about sexually transmitted diseases, and 31 percent about HIV/AIDS.

Surprisingly, mammography rates among women aged 40 to 64 have fallen slightly, from 73 percent in 2001 to 69 percent in 2004. Women with private coverage (74 percent) or Medicare (73 percent) were more likely to have had this screening than uninsured women (40 percent).

“Part of it is in the 40- to 49-year-old group, where there has really been a lot of conflicting press reports,” Salganicoff said. “I think women are confused and health-care providers don’t agree, and there are cost issues that are associated with a mammography.”

Pap smear rates have also declined, from 81 percent in 2001 to 76 p