THE HEALTH POLICY GAP: INCOME, HEALTH INSURANCE AND SOURCE OF CARE EFFECTS ON UTILIZATION OF AND ACCESS TO DENTAL, PHYSICIAN AND HOSPITAL SERVICES BY OREGON HOUSEHOLDS.

摘要

This study explores the effects of income, insurance, and source of medical care on access to and utilization of health services. Profiles of dental, physician, and hospital services use are developed for more than 3,500 Oregonians. Low income, lack of health insurance, and/or an inappropriate source of medical care are hypothesized to be barriers to access and utilization. Households which face one or more of these barriers are identified as falling into a "Health Policy Gap.".;Income is found to be related to insurance coverage, and insurance coverage to source of medical care, although income is not found to be directly related to source of care. Low income, lack of insurance, and an inappropriate source of medical care depress use across almost all services. However, their relative barrier effects differ by the measure of service examined. After controlling for the effects of household structure, health need, residential mobility, and health behaviors, the greatest disparity in use of dental services remains due to income, in physician services to insurance and income, and in hospital services to insurance.;Since the relative magnitude of these barrier effects varies by the health measure examined, neither income, insurance, nor health system delivery strategies can be assumed to evenly enhance use patterns. Their effects must be separately estimated for differing measures of health services. Furthermore, the relationship between these policy variables needs detailed study before large-scale policy interventions are undertaken.;The data for this study were drawn from a 1978 random telephone survey of 1249 Oregon households. A behavioral model of health services utilization was constructed, dividing the independent variables according to their relative mutability or amenity to policy intervention. Multiple techniques of analysis were employed, including cross-tabular procedures, multiple linear regression, partial correlation, analysis of variance and multiple classification.