Children's health outcomes in six different ambulatory care delivery systems.

This study assesses health outcomes across six widely varying delivery settings within one population sample, describing differences between actual and expected illness prevalences among children using each type of setting as a regular source. Illness measures are from independent clinical examinations of the children for anemia, acute and chronic ear problems, hearing loss and vision disorders. Comparisons of actual with expected prevalences based on each setting's patient clientele reveal three systematic patterns: children using solo practitioners had generally higher-than-expected illness prevalences, while those using the prepaid group and hospital outpatient departments had uniformly lower-than-expected prevalences. These differentials were not related to patients' economic status or to selection of providers according to recent children's health problems, and, for the prepaid group and solo practice, they were generally stronger among more exclusive users of each setting. Thus, the illness differentials appeared to represent outcomes related to system differences in quality of care. Although the differentials were small and not all were statistically signifiant, they may have substantial policy significance. Some unusual as well as characteristic features of each setting are discussed which may explain these system differentials.