Influence of the Majority Source of Care on Preventive Care. Abstract, ExecutiveSummary and Dissertation

摘要

This study examines the influence of the health care setting on receipt ofpreventive care for low-income populations. Data are from the 1987 National Medicare Expenditure Survey. The sample consisted of 17,328 nonelderly people with at least one physician visit. The health setting (where over 50 percent of physician visits were received) was associated with the likelihood of a preventive visit. After adjusting for intervening variables, an association between the health care setting and receipt of preventive care was found. Compared to those using physician (MD) offices, emergency department (EDs) users were less likely to have a preventive visit and Medicaid and low-income populations using clinic care had a higher odds of a preventive visit. The site was not found to influence immunization rates. Women who obtained their care from hospital outpatient departments (HOPDs) were more likely to have had a Pap smear or a breast exam than those using MD offices. Those using EDs for most of their care were less likely to have a Pap smear or a breast exam than MD users. For vulnerable populations, the results suggest that persons relying on HOPDs or clinics are more likely to get preventive care than those using MD offices.