The effects of poverty and minority status on ambulatory care use.

The objective of this dissertation is to assess the independent and interactive effects of poverty and minority status on the use of ambulatory health services. Attention is paid both to initiation and volume of care. Although substantial public investments have been made to improve financial accessibility to care, recent evidence suggests that reductions in these programs may have eroded the progress made toward that goal since the mid-1960's. The data were derived from the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES), a longitudinal survey based on a sample of 17,123 persons representing the civilian noninstitutionalized population in the U.S. Two types of analysis were conducted: (1) A profile of socioeconomic and health-related traits for each of four groups of interest defined by poverty and minority status was presented in terms of bivariate statistics. (2) The hypotheses regarding the effects of poverty and minority status on use of service were tested, controlling for health status, by using cumulative logit analysis. This technique permits comparison of ordinal frequency distributions across population subsets and construction of a single model to explain both the initiation and volume of ambulatory care use. Odds ratios were also computed to ascertain the magnitude of the effects observed. Overall, the results of this analysis suggest that initial access to medical care is more of a problem than is obtaining care once it has been initiated. Regardless of poverty status, Blacks are less likely to initiate care than are whites. Poverty depresses initiation of care for three groups: poor whites and poor Blacks in "fair" or "poor" health and poor Blacks in "good" health. The poverty effect among those in ill health is opposite for Blacks relative to whites. Among whites in ill health the poor are half as likely as to initiate care as the nonpoor. Conversely, among Blacks in ill health, the nonpoor are less than half as likely as the poor to initiate care. Poverty effects on the volume of use were observed only among whites in "fair" or "poor" health and among Blacks in "good" health. In each case, poverty serves to depress utilization. (Abstract shortened with permission of author.)Ph.D.Public healthEthnic studiesUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161848/1/8812964.pd