Variation in the Ecology of Medical Care

George E. Fryer; Larry A. Green; Susan M. Dovey; Barbara P. Yawn; Robert L. Phillips; David Lanier

doi:10.1370/afm.52

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Table 1.

Variation in the Number of Persons Who Received Care in Different Health Care Settings in the United States in 1996 (persons per 1,000/mo), by Sociodemographic Characteristics.

Demographic Characteristic	Hospital Stays No. (SE)	Outpatient Department Visits No. (SE)	Emergency Department Visit No. (SE)	Office Visits No. (SE)	Home Health Care No. (SE)
SE = standard error, GED = general equivalency diploma, MSA = metropolitan statistical area county.
Age (y)
< 5	5.6 (0.9)	11.8 (1.2)	18.6 (1.3)	243.5 (7.2)	2.2 (0.9)
5–17	2.4 (0.4)	7.0 (0.7)	11.4 (0.6)	144.6 (3.5)	1.7 (0.6)
18–24	6.8 (0.8)	9.9 (1.1)	18.0 (1.5)	140.1 (5.2)	2.0 (0.9)
25–44	6.8 (0.4)	17.0 (1.0)	2.3 (0.5)	191.8 (3.8)	4.4 (0.8)
45–64	9.0 (0.6)	32.7 (1.7)	10.8 (0.6)	262.7 (5.0)	9.0 (1.2)
≥ 65	20.2 (1.1)	50.8 (2.6)	14.0 (0.8)	383.8 (7.4)	73.6 (4.7)
Sex
Female	9.0 (0.4)	25.0 (1.1)	13.3 (0.4)	255.5 (3.4)	17.4 (1.2)
Male	6.9 (0.4)	17.7 (0.8)	12.6 (0.5)	181.0 (3.1)	8.2 (0.9)
Race
White	8.2 (0.3)	23.0 (0.8)	13.1 (0.4)	232.9 (3.1)	13.0 (0.9)
African American	7.2 (0.8)	15.7 (1.6)	13.2 (0.9)	154.0 (4.4)	14.3 (2.1)
Asian Pacific Islander	4.4 (0.8)	10.0 (2.6)	5.1 (1.1)	153.0 (10.1)	6.3 (2.8)
American Indian	7.2 (2.0)	11.3 (2.2)	21.1 (3.6)	182.9 (23.1)	15.1 (8.3)
Ethnicity
Non-Hispanic	8.1 (0.3)	22.6 (0.8)	3.0 (0.4)	227.0 (3.0)	13.7 (0.9)
Hispanic	6.7 (0.6)	12.1 (1.1)	12.9 (0.9)	155.7 (5.2)	7.0 (1.1)
Household income as percent of federal poverty level
≥ 400%	6.2 (0.4)	22.6 (1.1)	9.5 (0.5)	246.5 (4.4)	7.5 (1.0)
200%–399%	6.9 (0.4)	19.4 (0.9)	11.8 (0.5)	207.5 (3.6)	7.3 (1.1)
125%–199%	10.0 (0.8)	21.8 (1.8)	15.8 (1.0)	205.1 (5.7)	19.2 (2.9)
100%–124%	9.6 (1.3)	24.8 (3.9)	17.6 (2.1)	196.3 (9.0)	31.6 (5.5)
< 100%	11.3 (0.9)	21.5 (1.7)	18.8 (1.0)	202.8 (5.6)	25.5 (2.8)
Education of head of household
No degree	11.0 (0.8)	23.8 (1.6)	17.1 (0.9)	201.5 (5.4)	29.6 (3.0)
Graduated high school, GED	8.1 (0.4)	21.1 (0.9)	13.4 (0.5)	210.7 (3.6)	10.4 (0.9)
Degree beyond high school	5.8 (0.4)	20.5 (1.2)	9.9 (4.3)	243.6 (4.8)	7.5 (1.1)
Residence location
MSA	7.6 (0.3)	20.3 (0.7)	12.3 (0.4)	220.7 (3.0)	11.6 (0.9)
Non-MSA	9.2 (0.8)	25.7 (2.2)	15.8 (0.9)	213.2 (6.6)	18.2 (2.3)
Insurance status
Insured	8.7 (0.4)	23.5 (0.9)	12.9 (0.4)	239.7 (3.0)	15.0 (1.0)
Uninsured	3.9 (0.5)	11.0 (1.0)	13.3 (0.8)	116.6 (3.9)	2.8 (0.9)
Usual source of care
A usual source of care	8.7 (0.3)	24.1 (0.9)	13.5 (0.4)	244.6 (3.1)	14.5 (1.0)
No usual source of care	4.6 (0.5)	8.8 (0.8)	10.3 (0.6)	99.2 (3.8)	5.4 (1.2)

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Table 2.

Adjusted Odds Ratios That a Person With Particular Characteristics Received Health Care in Selected Settings in the United States in a Typical Month in 1996.

Demographic Characteristic	Hospital Stays OR (95% CI)	Outpatient Department Visits OR (95% CI)	Emergency Department Visits OR (95% CI)	Office Visits OR (95% CI)	Home Health Care Visits OR (95% CI)
Note: The most populated, modal group was designated as the referent.
GED = general equivalency diploma, MSA = metropolitan statistical area county.
* P < .001.
† P < .05.
‡ P < .01.
Age (y)
< 5	0.51 (0.39–0.67)*	0.65 (0.52–0.83)*	.38 (1.16–1.63)*	2.41 (1.99–2.91)*	0.51 (0.27–0.96)^†
5–17	0.27 (0.20–0.35)*	0.42 (0.35–0.50)*	0.87 (0.77–0.99)^†	0.83 (0.75–0.92)*	0.29 (0.16–0.52)*
18–24	1.03 (0.79–1.34)	0.66 (0.54–0.81)*	1.47 (1.22–1.76)*	0.88 (0.76–1.03)	0.50 (0.24–1.04)
25–44	1.00	1.00	1.00	1.00	1.00
45–64	1.13 (0.96–1.32)	1.78 (1.57–2.02)*	0.86 (0.75–0.99)^†	1.40 (1.25–1.56)*	1.64 (1.16–2.32)^‡
≥ 65	2.07 (1.73–2.49)*	2.79 (2.39–3.26)*	0.97 (0.84–1.13)	2.98 (2.50–3.54)*	8.28 (6.15–11.14)*
Sex
Female	1.00	1.00	1.00	1.00	1.00
Male	0.73 (0.65–0.82)*	0.74 (0.67–0.81)*	1.00 (0.91–1.10)	0.55 (0.51–0.59)*	0.63 (0.52–0.77)*
Race
White	1.00	1.00	1.00	1.00	1.00
African American	0.91 (0.75–1.10)	0.73 (0.61–0.86)*	0.83 (0.72–0.96)^†	0.62 (0.55–0.69)*	1.06 (0.80–1.41)
Asian Pacific Islander	0.73 (0.49–1.08)	0.50 (0.32–0.79)*	0.38 (0.24–0.60)*	0.55 (0.43–0.71)*	0.68 (0.37–1.26
American Indian	0.93 (0.53–1.63)	0.89 (0.55–1.43)	1.42 (0.96–2.11)	0.77 (0.51–1.18)	1.62 (0.70–3.72)
Ethnicity
Non-Hispanic	1.00	1.00	1.00	1.00	1.00
Hispanic	1.03 (0.86–1.24)	0.72 (0.61–0.86)*	0.80 (0.70–0.93)‡	0.79 (0.71–0.89)*	0.77 (0.55–1.07)
Household income as percent of federal poverty level
≥ 400%	1.00	1.00	1.00	1.00	1.00
200%–399%	1.13 (0.97–1.31)	0.97 (0.86–1.09)	1.18 (1.04–1.35)^†	0.90 (0.80–1.01)	1.05 (0.77–1.43)
125%–199%	1.68 (1.38–2.04)*	1.05 (0.90–1.23)	1.47 (1.26–1.71)*	0.87 (0.75–1.01)	1.84 (1.27–2.66)^‡
100%–124%	1.69 (1.27–2.24)*	1.17 (0.91–1.49)	1.38 (1.09–1.74)^‡	0.96 (0.77–1.20)	3.32 (2.10–5.24)*
<100%	2.04 (1.69–2.46)*	1.13 (0.96–1.34)	1.80 (1.52–2.12)*	1.00 (0.86–1.17)	2.85 (2.03–4.01)*
Education of head of household
No degree	1.09 (0.92–1.30)	0.96 (0.84–1.11)	1.13 (0.99–1.30)	0.77 (0.68–0.88)*	1.24 (0.98–1.58)
Graduated high school, GED	1.00	1.00	1.00	1.00	1.00
Degree beyond high school	0.82 (0.71–0.96)^†	0.98 (0.87–1.10)	0.84 (0.76–0.94)‡	1.39 (1.24–1.56)*	1.22 (0.91–1.64)
Residence location
MSA	1.00	1.00	1.00	1.00	1.00
Non-MSA	1.04 (0.89–1.21)	1.13 (0.96–1.33)	1.13 (0.99–1.30)	0.88 (0.79–0.99)^†	1.15 (0.94–1.42)
Insurance status
Insured	1.00	1.00	1.00	1.00	1.00
Uninsured	0.50 (0.39–0.65)*	0.66 (0.56–0.78)*	0.93 (0.81–1.06)	0.55 (0.49–0.62)*	0.48 (0.28–0.83)^‡
Usual source of care
Has a usual source of care	1.00	1.00	1.00	1.00	1.00
No usual source of care	0.57 (0.46–0.71)*	0.43 (0.36–0.50)*	0.73 (0.64–0.84)*	0.28 (0.25–0.31)*	0.58 (0.40–0.86)^‡

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Table 3.

Variation in the Ecology of Medical Care Associated with Having Health Insurance or a Usual Source of Care in 1996 in the United States

Received Care in This Setting	Neither Insurance or Usual Source	Only Insurance	Only Usual Source	Both Insurance and Usual Source
Note: persons per 1,000 /mo with insurance and usual source of care receiving health care in different settings.
Physician office	62	119	149	258
Hospital outpatient	5	11	14	25
Emergency department	10	10	15	13
Home	2	8	3	16
Hospital	2	8	3	9