DETERMINANTS OF MEDICAL HEALTH SERVICES UTILIZATION.
Item
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Title
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DETERMINANTS OF MEDICAL HEALTH SERVICES UTILIZATION.
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Identifier
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AAI8014956
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identifier
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8014956
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Creator
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BORGATTA, MARIE L.
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Contributor
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Samuel W, Bloom | David E. Lavin
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Date
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1980
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Language
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English
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Publisher
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City University of New York.
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Subject
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Sociology, Theory and Methods
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Abstract
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This thesis reports a systematic study of the determinants of medical services utilization. It is based on an interview survey (LAMAS VI) of a probability sample of 1006 households in the Los Angeles Metropolitan Area. The research instrument was designed, and the data collected (1973) under the direction of Professor Leo G. Reeder at the UCLA Survey Research Center.;A series of regression analyses were carried out corresponding to descriptive models of health services utilization. Five dependent variables of health services utilization were developed. The first was total physician usage, on an ambulatory basis, for a two-month period preceding the interview. Three additional variables specified types of physician attention sought for up to five visits during that period: Visits for new conditions, visits for continuing or chronic conditions, and preventive visits. A fifth dependent variable measured the number of hospital stays during the year.;A broad array of independent variables tapped health status, economic means (including insurance coverage), convenience of services, satisfaction with services, and other social and psychological characteristics or attributes that might be expected to influence use of health services.;The regression analysis for the whole sample (adult respondents 18 years and older) indicated that females were higher users of services on four of the utilization measures; the exception was physician visits for continuing conditions. Separate, parallel analyses were applied to various groups subdivided according to age and sex. The dependent variable for which the greatest amount of variance was predicted, consistently across all groups, was the overall measure of ambulatory physician use, the predicted variance ranging from 24 percent for all females to 38 percent for males over 45 years of age. When physician visits were separated into three types according to the main reasons for seeking care, the amount of predicted variance, from greatest to least, was: for chronic condition (19 to 36 percent); for new condition (7 to 22 percent); for preventive services (zero to 10 percent). The predicted variance for the hospitalization measure ranged from 10 to 17 percent. For all dependent variables, the best predictions occurred with male subgroups, strongly suggesting that health services utilization by males, especially older ones, is considerably more predictable than that for females.;The final descriptive models were rather simple. With a few exceptions, most final models retained only two to six independent predictors. Health need variables were prominent in the prediction of all dependent variables except for preventive use. Medicaid coverage contributed towards the prediction of the frequency of hospitalization, and also physician use, especially when attention was sought for chronic conditions. With regard to hospitalization, however, the most important predictor was a predispositional measure: psychological distress. Psychological distress was also associated with the overall measure of ambulatory physician use for some groups, but was not predictive relative to any of the three specified types of physician visits. Hospital experience was itself predictive of overall physician use and of use for chronic conditions.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
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Program
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Sociology
