Freeborn D K, Pope C R, Davis M A, Mullooly J P
Med Care. 1977 Feb;15(2):115-28. doi: 10.1097/00005650-197702000-00002.
When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income.
在评估医疗保健项目的有效性时，一个令人担忧的问题是接受治疗是基于医疗需求还是社会经济地位。本研究描述了健康状况与社会经济地位之间的关系，并试图确定哪一个对门诊医疗利用有更大的影响。研究背景是一个运营中的健康维护组织（HMO），其横断面会员人数近20万。门诊利用数据来自1969年和1970年健康计划成员5%样本的医疗记录。社会、经济、状况和态度数据由2603名受访者在家庭访谈调查中提供。由于人群的感知健康状况可能反映健康需求，调查信息提供了从特定症状和抱怨到感知健康状况总体衡量的健康状况指标。尽管根据所考虑的变量不同，研究结果有所差异，但总体而言，在这个医疗保健系统中，健康状况与服务利用的相关性高于社会经济因素。一个例外是预防性服务的使用，它与健康状况指标没有显著关系，而对于女性来说，与教育程度有关，在较小程度上与收入有关。
