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New Study Provides “Snapshot” of Health-Care Use in the United States and How Socioeconomic Variables Affect It

FOR IMMEDIATE RELEASE
Tuesday, July 29, 2003

Contact:
Leslie Champlin
American Academy of Family Physicians
(800) 274-2237, Ext. 5224
lchampli@aafp.org

WASHINGTON -- A new study shows that most people interact with the health-care system in physicians’ offices. The authors concluded that doctors’ offices have the potential to affect the largest number of people from all sociodemographic sectors in the United States.

The study, “Variation in the Ecology of Medical Care," published in the July 29 Annals of Family Medicine, shows that people without a usual source of care -- a person or place that someone normally goes to when sick -- were less likely to seek health care in the five health care settings studied. Lack of health insurance was associated with lower rates of care in four of the settings but not emergency rooms. More complicated patterns of interaction with the health-care system were found for most sociodemographic variables.

“From a policy perspective, having a usual source of care and health insurance is the most amenable health arrangement to intervention,” wrote the authors. “One can imagine policy options that would assure one or the other or both.”

Researchers at the Robert Graham Center: Policy Studies in Family Practice and Primary Care in Washington, D.C., focused on population to show the variation in how individuals actually participated in the health-care system during a typical month. The researchers looked at five health-care locations: physicians’ offices, outpatient clinics, emergency departments, hospitals and homes. The study explored the likelihood of seeking care in the five settings using the variable of age, sex, race, ethnicity, residence, education of head of household and household income, and whether people had health insurance and a usual source of care.

“Our study is a snapshot of how things are in the health-care system -- it does not establish cause and effect,” explained George E. Fryer, Jr., Ph.D., lead author. “It does provide a framework for considering policy options and designing future research.”

Findings include:

Age: after 5, as patients aged, the likelihood of pursuing care increased in all health-care settings except emergency departments. Larger numbers of young children (under 5) and adults 18 to 24 years old received care in emergency departments than other age groups.
Sex: Women were more likely than men to obtain care in all five health-care settings.
Race: Similar proportions of African Americans and whites sought services in emergency departments, hospitals and their homes, but smaller proportions of African Americans sought care in hospital outpatient departments and physicians’ offices. A smaller proportion of Asians than either African Americans or whites obtained care in all settings except physicians’ offices. American Indians differed most from African Americans and whites in hospital outpatient departments, where a smaller proportion were seen, and in emergency rooms, where a larger proportion were seen.
Ethnicity: A smaller proportion of Hispanics than non-Hispanics sought care in all settings except the emergency department, where similar proportions received care.
Household income: Larger proportions of poor persons obtained care in emergency departments, hospitals and their homes; smaller proportions sought care in physicians’ offices.
Education of head of household: Higher educational attainment was associated with a greater likelihood of visiting physicians’ offices and less likelihood of hospitalization and emergency room care.
Residence location: A larger proportion of people living outside of urban areas (metropolitan statistical areas) sought care in all settings except physicians’ offices.

“After controlling for all of these variables, there is one health-care setting in which there is unequal access: the physician’s office for persons of color and for Hispanics,” explained Larry A. Green, M.D., director of the Robert Graham Center. “Physicians’ offices are the single largest platform of delivery of health care in the United States. The designs and infrastructures that sustain them will remain central to achieving important policy objectives.”

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Founded in 1947, the AAFP represents more than 93,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.

Nearly one in four of all office visits are made to family physicians. That is 215 million office visits each year – nearly 48 million more than the next medical specialty. Today, family physicians provide the majority of care for America’s underserved and rural populations.

In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, family physicians are dedicated to treating the whole person across the full spectrum of ages. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

To learn more about the American Academy of Family Physicians and about the specialty of family medicine, please visit www.aafp.org.

For more information about the AAFP's positions on issues and clinical care and downloadable multi-media on family medicine and health care, visit the AAFP Media Center.

For more information about health care, health conditions, and wellness, please visit familydoctor.org.

The Annals of Family Medicine is a new peer-reviewed research journal dedicated to advancing knowledge essential to understanding and improving health and primary care. It is sponsored by the American Academy of Family Physicians, American Board of Family Practice, Society of Teachers of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, and the North American Primary Care Research Group.

The Robert Graham Center conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the Center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians. For more information, please visit www.graham-center.org.

The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the AAFP.