Access to health services in an urban community: Does source of care make a difference?

Research output: Contribution to journalArticle

Abstract

The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P ≤ .05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72% less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However, type of site used was unrelated to utilization. The impact of having a usual source of care appears to be independent of the effect of having a primary clinical provider, suggesting that having an initial portal into the health care system is as important as possessing an ongoing relationship with a clinician in ensuring access to services. Socioeconomic factors remain important influences on gaining entry into the health care system.

Original languageEnglish (US)
Pages (from-to)186-199
Number of pages14
JournalJournal of Urban Health
Volume79
Issue number2
DOIs
StatePublished - 2002

Fingerprint

Urban Health Services
health service
utilization
Delivery of Health Care
Health Services
health care
Preventive Health Services
Patient Acceptance of Health Care
medical care
community
Sampling Studies
Social Class
socioeconomic factors
health care services
Cross-Sectional Studies
Logistic Models
Regression Analysis
social status
regression analysis
illness

Keywords

  • Access to Health Care
  • African Americans
  • Urban Health Services
  • Usual Source of Medical Care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

@article{a5e09e7aa1e7466da0f961b4e263fd01,
title = "Access to health services in an urban community: Does source of care make a difference?",
abstract = "The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P ≤ .05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72{\%} less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However, type of site used was unrelated to utilization. The impact of having a usual source of care appears to be independent of the effect of having a primary clinical provider, suggesting that having an initial portal into the health care system is as important as possessing an ongoing relationship with a clinician in ensuring access to services. Socioeconomic factors remain important influences on gaining entry into the health care system.",
keywords = "Access to Health Care, African Americans, Urban Health Services, Usual Source of Medical Care",
author = "Cheryl Merzel and Joyce Moon-Howard",
year = "2002",
doi = "10.1093/jurban/79.2.186",
language = "English (US)",
volume = "79",
pages = "186--199",
journal = "Journal of Urban Health",
issn = "1099-3460",
publisher = "Springer Science and Business Media Deutschland GmbH",
number = "2",

}

TY - JOUR

T1 - Access to health services in an urban community

T2 - Does source of care make a difference?

AU - Merzel, Cheryl

AU - Moon-Howard, Joyce

PY - 2002

Y1 - 2002

N2 - The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P ≤ .05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72% less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However, type of site used was unrelated to utilization. The impact of having a usual source of care appears to be independent of the effect of having a primary clinical provider, suggesting that having an initial portal into the health care system is as important as possessing an ongoing relationship with a clinician in ensuring access to services. Socioeconomic factors remain important influences on gaining entry into the health care system.

AB - The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P ≤ .05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72% less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However, type of site used was unrelated to utilization. The impact of having a usual source of care appears to be independent of the effect of having a primary clinical provider, suggesting that having an initial portal into the health care system is as important as possessing an ongoing relationship with a clinician in ensuring access to services. Socioeconomic factors remain important influences on gaining entry into the health care system.

KW - Access to Health Care

KW - African Americans

KW - Urban Health Services

KW - Usual Source of Medical Care

UR - http://www.scopus.com/inward/record.url?scp=0036272029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036272029&partnerID=8YFLogxK

U2 - 10.1093/jurban/79.2.186

DO - 10.1093/jurban/79.2.186

M3 - Article

C2 - 12023494

AN - SCOPUS:0036272029

VL - 79

SP - 186

EP - 199

JO - Journal of Urban Health

JF - Journal of Urban Health

SN - 1099-3460

IS - 2

ER -