Modifiable Determinants of Healthcare Utilization: RESULTS
There was valid data for 3,462 African-American respondents to the survey, representing a U.S. African-American population of 36,538,639 civilian, noninstitutionalized persons. Respondents had a median age of 30.0 years. Differences in self-reported health status and mental health status were not striking, but showed a predictable decline in health status with age, and worse health status associated with rural residence and with being publicly insured (Medicare or Medicaid). African-American individuals living in rural areas were also a bit more likely to be older (median age 31.0 years for non-MSA and 29.0 years for MSA). We also found that the “near poor”, who may not qualify for Medicaid nor be able to afford private insurance, had worse health status than either the poor or any other income group.
The pattern of healthcare utilization for African-American persons by demographic and other characteristics in 1999 is depicted in Table 1. Variations are seen by age group and gender. Elderly and female African-American persons used more healthcare in all settings and received more medications during the year than did younger and male African Americans. With the exception of hospital outpatient departments, African Americans living in rural (non-MSA) areas were more frequent users of care in all settings, with rural residents spending three times as many days in the hospital as MSA residents. This may reflect the greater proportion of African-American elders remaining in rural areas. After controlling for age, gender, and insurance status, rural residence was not a significant factor related to healthcare utilization of any service except hospitalization. The poorest group used services most often in every setting other than providers’ offices, but the near-poor, who are less likely to qualify for Medicaid, had lower utilization. cheap antibiotics
In the 1999 MEPS sample, 14.5% of African Americans were uninsured, and 20% had no usual source of care. Health insurance status is strongly related to healthcare utilization. African Americans who were uninsured trailed both insured categories for all settings of care other than the emergency room. Those with only public health insurance were much greater consumers of healthcare, reflecting higher utilization by the elderly (Medicare/Medic-aid) and by the poor (Medicaid). For example, those with public health insurance obtained prescription medication at a rate five times higher than did the uninsured. This pattern of higher utilization for the insured vs. the uninsured (in all settings except the emergency room) held true as well for the subgroup of nonelderly adults (i.e., when children and the elderly were excluded).
African Americans with a usual source of care also used outpatient visits, inpatient hospital bed-days, and prescription drugs two-to-four times more often than those without such an arrangement. Having a usual source of care did not significantly affect ED visits, which were much more strongly associated with insurance status. kamagra soft tablets
Results of seven separate regression procedures for utilization in each setting and prescribed medications are portrayed in Table 3. It illustrates the unique contribution of each predictor characteristic and healthcare arrangement. Controlling for the effects of all other predictors, several factors were significantly associated with each utilization measure, and the overall model was significant in predicting utilization (p<0.01). Although poverty was a significant factor for some types of utilization, age, health insurance status, and having a usual source of care were the most important predictors of utilization for African-American persons in 1999.
Table 4 depicts a comparison of two groups with very different capacities to obtain needed health care. Members of the disadvantaged group have family income below the poverty level, no health insurance, and no usual source of care. In the U.S. population, this represents over a half million (527,474) “healthcare disadvantaged” persons, or 1.4% of our entire sample. The advantaged group has family income above 400% of poverty, health insurance, and a usual source of care. This is actually a much larger group, representing more than six million (6,169,181) African Americans (17.1% of the study population) in 1999. These data should be interpreted with caution due to the small number of MEPS participants in each subgroup. buy antibiotics canada
Utilization in all settings except the emergency room was dramatically greater for African Americans with the necessary financial means and arrangements to obtain care. There was also an interesting relationship between hospitalizations and ED visits. The most-disadvantaged African-American patients had only one hospital admission for every 10 ED visits, but insured, middle- and upper-income African-American patients with a usual source of care had a hospitalization for every two ED visits. Focusing on the impact of insurance status among adult patients age 18-64, the uninsured had 3.6 ED visits per hospital admission, while the insured were hospitalized once for every 1.7 ED visits.
