Yelin E H, Kramer J S, Epstein W V
Am J Public Health. 1983 May;73(5):563-71. doi: 10.2105/ajph.73.5.563.
Previous studies of medical care utilization have controlled for medical need by signs or symptoms or broad disease classifications. The present study uses both symptoms and discrete diagnoses to control for medical need in order to determine if the use of ambulatory and hospital care differs by race, income, education, insurance coverage, or region. Using data from the 1976 National Health Interview Survey, we found that there were no consistent differences in the number of physician visits made in a year by these characteristics, medical need held constant. Lack of insurance coverage was associated with fewer hospitalizations in a year for five of nine chronic diseases under review. Race was associated with fewer hospitalizations for two conditions prevalent among minorities. These effects were not evident when medical need was controlled solely by signs or symptoms.
以往关于医疗服务利用的研究通过体征或症状或宽泛的疾病分类来控制医疗需求。本研究使用症状和明确诊断两者来控制医疗需求，以确定门诊和住院治疗的使用在种族、收入、教育程度、保险覆盖范围或地区方面是否存在差异。利用1976年全国健康访谈调查的数据，我们发现，在医疗需求保持不变的情况下，按这些特征划分，一年中看医生的次数没有一致的差异。在所审查的九种慢性病中，有五种疾病显示，缺乏保险覆盖与一年中住院次数较少有关。种族与少数族裔中普遍存在的两种疾病的住院次数较少有关。当仅通过体征或症状来控制医疗需求时，这些影响并不明显。
