Breen NA, Parsons PE, Milcarek B, Evans T, Brundage T.
AHSR FHSR Annu Meet Abstr Book. 1996; 13: 150.
Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, MD 20892, USA.
RESEARCH OBJECTIVES: The Black Report found for the British population that social class inequalities in utilization appear to be greatest in the case of preventive services. This study examines two research questions. First, are differences in access to preventive care in the U.S. related to social class? Second, does access to health insurance and a usual source of care attenuate differences in access by social class? STUDY POPULATION: The study population includes 21,028 respondents to the 1993 National Health Interview Survey, which is a nationally representative household survey of the civilian, noninstitutionalized U.S. population. The study is limited to persons 18 or older who responded to the Year 2000 Objectives questions. STUDY DESIGN: After careful analyses of descriptive statistics and taking race/ethnicity and gender into account, multivariate logistic regression models were developed to measure the odds ratios associated with social class (income and education) and structural access (usual source of care and health care coverage) on use of preventive services (routine check-ups, cholesterol tests, blood pressure screening, and screening mammograms). Models were compared using the Akiake Information Criterion, which permits "goodness of fit" comparisons among models with different numbers of explanatory variables. PRINCIPAL FINDINGS: Clear social class gradiants for all four preventive services studied were found, though they were less dramatic among persons 65 and older. In general, Americans are not getting the preventive care they need. Persons without insurance or with only public insurance used preventive services at especially low rates. Medicaid and Medicare provide relatively few preventive services and persons 65 and older who are able to supplement Medicare with private insurance are more likely to use preventive services than those who do not. CONCLUSIONS: There are important differences in use of preventive services by social class. Structural access does attenuate these differences. Medicaid reduces social class differences in use of preventive services among women. Medicare reduces social class differences in utilization among those 65 and older. Having a usual source of care increases use of preventive services and women are more likely than men to have one. RELEVANCE TO POLICY: Increased use of preventive services could result from appropriately tailored efforts to promote preventive services among persons with lower incomes and less educational attainment. Medicaid recipients and Medicare beneficiaries could benefit from the provision and promotion of more preventive services. Because having a usual source of care is critical to use of preventive services, wise health policy would facilitiate access to a usual source of care.
Publication Types:
Keywords:
- African Americans
- Data Collection
- Delivery of Health Care
- Dental Care
- Educational Status
- Ethnic Groups
- European Continental Ancestry Group
- Female
- Health Policy
- Health Services Needs and Demand
- Humans
- Income
- Insurance, Health
- Male
- Medicaid
- Medicare
- Social Class
- Socioeconomic Factors
- United States
- economics
- hsrmtgs
Other ID:
UI: 102222343
From Meeting Abstracts