An Economic Analysis of the Dem and for Medical Care: Differences By Race.

One of the most important movements of the past two decades has been trying to attain equity and equality in access to medical care for all Americans. Even though there are currently many sources of data that show that blacks, in the aggregate, visit physicians as often as whites, one must still ask if this means that access has been achieved. The purpose of this research was to construct an economic model to try to determine (1) whether patterns of care are different for blacks and whites even when the number of visits appears the same, and (2) whether the observed equality would still exist if blacks had "equality of opportunity" as whites e.g., had the same health status, income, education as whites, on the average. A reappraisal of the access issue is particularly timely in light of the recent budgetary cuts of government programs which in the past have been thought to have contributed significantly to improving the "plight" of blacks. The Center for Health Administration Studies' 1975 Medical Access Study data were used to compare the dem and behavior of blacks and whites using multivariate analysis. The data were stratified into eight separate race/sex/marital status groups. Separate dem and (utilization) equations for ambulatory care were then estimated for each group using a tobit multivariate technique. Tobit rather than ordinary least squares is used because utilization equations violate an important assumption of OLS namely that the dependent variable range between - (INFIN) and (INFIN). Tobit takes account of the fact that visits are constrained to be zero or greater in number. The results of the empirical analysis of dem and show differences in behavior between blacks and whites (indeed between all eight groups). In general these differences are of two types. First, even though blacks are in poorer health status, on the average than whites, they wait until they are much sicker than whites to go to the doctor the first time. For example, when comparing Black married (BMW) women to white married women (WMW), BMW statistically are not observed to go to the physician at all when they are in good health, where as WMW visit the physician over twice yearly for this health status level. However, when blacks are in poor health they visit physicians over 14 time a year when the numbers of visits is corresponding smaller for WSW (10.4 visits). The second major difference is that some black's dem and responds to economic variables, in particular price, where as whites in general do not. The price elasticity of dem and is in the range of .5 - 1.5, larger than reported in most other studies. Using the tobit regression results I construct my own access indicators in the following manner. I do this by using an economic decomposition technique which allows me to separate the differences in behavior into two types: differences because mean characteristics of the groups are different (education, sex, health status, etc.) and differences due to dissimilar responses in slope coefficients. This allows me to answer the question of how currently observed utilization levels for blacks would compare to those that would be predicted if blacks had equal health status, income, education and insurance coverage, etc., as whites. I find that blacks might visit the doctor as much as ten percent more than currently if they had equality of opportunity. The policy implications are that budget cuts in federally funded programs may once again force a wedge between the numbers of visits blacks and whites consume. On the other h and , if programs are reinstated or exp and ed, blacks can be expected to try to increase their use of physician services.PhDEconomicsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/157917/1/8025683.pd