Education and Income Effects in the Use of Ambulatory Services in the United States

Abstract

The roles of education and income as determinants for utilization of ambulatory services in the U.S. are investigated by the application of path analysis to a subsample of the 1970 National Health Interview Survey. The methodology permits the identification of both the direct and indirect effects of each independent variable on utilization within a model that views need as the major determinant of care. Previous findings that income has no direct effect on utilization, while education does, are reaffirmed. Contrary to previous analyses, however, it is shown that income does have a strong indirect effect on utilization via its impact on need arising from chronic conditions, measured as limitation of activity. Individuals in the highest income category have a mean annual visit rate of 4.13, while the rate for those in the lowest is 5.43. Most of the differential, 1.3, is attributable to the lower prevalence of chronic conditions in the highest income bracket. The total effect of education, on the other hand, is only 60 percent of its direct effect since higher educational attainment is associated with lower levels of chronicity. Disaggregation of direct and indirect effects through the need variables shows that income has a greater effect on utilization than does education.

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References

Volume of Physician Visits, United States: July 1966-June 1967, Series 10, No. 49, Table 9. National Center for Health Statistics, Washington, D.C., November 1968.

Bice

T. W.

Eichorn

R. L.

Fox

P. D.

Socioeconomic status and use of physician services: A reconsideration. Med. Care 10: 261–271, 1972.

Lefcowitz

M. J.

Poverty and health: A re-examination. Inquiry 10: 3–13, 1973.

U.S. Bureau of the Census. Current Population Reports, Series P-60, No. 59, Income in 1967 of Families in the United States, Table 14. U.S. Government Printing Office, Washington, D.C., 1969.

U.S. Bureau of the Census. Current Population Reports, Series P-60, No. 64, Supplementary Report on Income in 1967 of Families and Persons in the United States, Table 9. U.S. Government Printing Office, Washington, D.C., 1969.

Berki

S. E.

Kobashigawa

Socioeconomic and need determinants of ambulatory care use: Path analysis of the 1970 Health Interview Survey data. Med. Care 14: 405–421, 1976.

U.S. Bureau of the Census. Current Population Reports, Series P-60, No. 75, Income in 1969 of Families and Persons in the United States, Table 6. U.S. Government Printing Office, Washington, D.C., 1970.

U.S. Bureau of the Census. Current Population Reports, Series P-60, No. 75, Income in 1969 of Families and Persons in the United States, Tables 2, 32, 33. U.S. Government Printing Office, Washington, D.C., 1970.

Mechanic

Medical Sociology, pp. 259–266. Free Press, New York, 1968.

10.

Conover

P. W.

Social class and chronic illness. Int. J. Health Serv. 3: 357–368, 1973.

11.

Bice

T. W.

Rabin

D. L.

Starfield

B. H.

White

K. L.

Economic class and use of physician services. Med. Care 11: 287–296, 1973.

12.

Wan

T. T. H.

Soifer

S. J.

Determinants of physician utilization: A causal analysis. J. Health Soc. Behav. 15: 100–108, 1974.