Thacker S B, Salber E J, Osborne C, Muhlbaier L H
Am J Public Health. 1978 Sep;68(9):853-7. doi: 10.2105/ajph.68.9.853.
In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care. Results showed that patients attending the private clinics are predominantly white and covered by private insurance, while patients attending the public clinics are predominantly black and heavily dependent on Medicaid coverage. The potentially detrimental effects of a two-class system of care on the health of patients, as well as on the education of students, is discussed in the context of a scant medical literature on this subject.
1975年至1976年，在北卡罗来纳州达勒姆县的所有门诊机构设施以及50家社区私人诊所中的47家开展了一项为期一年的初级保健服务提供情况纵向研究，这些私人诊所涵盖外科（包括泌尿外科和骨科）、内科、儿科以及妇产科等广泛领域。本文重点关注杜克大学医学中心的私立和公立诊所。对数据进行了分析，以记录就诊于这两种医疗体系的患者在社会人口学特征方面的差异。结果显示，就诊于私立诊所的患者主要为白人且有私人保险覆盖，而就诊于公立诊所的患者主要为黑人且严重依赖医疗补助覆盖。鉴于关于这一主题的医学文献匮乏，本文在这种背景下讨论了两级医疗体系对患者健康以及对学生教育可能产生的不利影响。
