Use of ambulatory medical care by the poor: another look at equity.

Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.