Aday L A
Milbank Mem Fund Q Health Soc. 1976 Spring;54(2):215-33.
This article presents national data on a social-indicator-type measure of access to medical care, prior to and after the introduction of Medicare and Medicaid in the United States. The analyses confirm that the access of the poor, especially those with a regular source of medical care did improve, relative to the non-poor, between 1963 and 1970. Access for middle-class and low-income persons with no usual doctor and the high-income with a regular family physician declined considerably over this period, however. One explanation of these findings proffered is that after Medicare and Medicaid were introduced, providers may have begun to ration the number of visits by the "well-to-do" to accommodate the influx of low-income patients with newly acquired purchasing power and a backlog of unmet need. Many poor with no previously established source of care continued to experience barriers to entry. Much more sophisticated analyses are required to test this and other propositions suggested here, however.
本文展示了美国在引入医疗保险和医疗补助计划之前和之后，关于获得医疗服务的一种社会指标类型衡量标准的全国性数据。分析证实，在1963年至1970年期间，相对于非贫困人口，贫困人口，尤其是那些有固定医疗服务来源的人的医疗服务可及性确实有所改善。然而，在此期间，没有固定医生的中产阶级和低收入人群以及有固定家庭医生的高收入人群的医疗服务可及性大幅下降。对这些发现提出的一种解释是，在引入医疗保险和医疗补助计划之后，医疗服务提供者可能开始限制“富裕人群”的就诊次数，以接纳新获得购买力且有大量未满足需求积压的低收入患者。许多以前没有固定医疗服务来源的贫困人口仍然面临就医障碍。然而，需要更复杂的分析来检验这一点以及本文提出的其他命题。
