Organisation of ambulatory care by consumers

This paper deals with how consumers arrange their ambulatory care in a system such as the United States which offers many possible choices. Patters of the different affiliations (sources) that people maintain throughout the year for ambulatory care are formed. The data were obtained in interviews in a sample survey of Rhode Island households conducted in 1974. Although most people in the sample (89.5 per cent) cluster with one to three sources of care, there were over 80 people with four or more affiliations. For those persons with a large number of affiliations, the provider sets become quite varied. Two conceptual typologies are formed, one focusing on type (private physicians versus places) and the other focusing on both the speciality of the physicians involved and the number of different affiliations involved. The United States, at least in theory, maintains a‘free market’health care system. Are there limitations of choice imposed by differential distributions of knowledge, income or age? A wide array of social, demographic, and illness variables were examined to determine their relationship to the patterns. Income has little relationship with the provider set patterns, but persons with a higher education are more likely to report a provider set that includes a primary care specialist (internist or paediatrician), rather than a general practitioner or osteopath. Blacks have different patterns of providers, as do those on Medicaid funding. Thus there is evidence of the continuation of a dual market for health care. The research describes the diversity and complexity of current health care patterns under a loosely structured system of health care such as that found in the United States. While the British health system has traditionally represented a tightly structured system with one path of entry (the general practitioner) into more complex health care services, this may be changing somewhat if current trends in the growth of the private insurance sector in Great Britain continue. Thus the experience of the United States may be of greater policy interest in Britain in the future. There has been a great deal of research in medical sociology and health services research dealing with health behaviour, especially as it relates to ambulatory medical care services. This paper examines how people structure their own health care with the presumably‘free market’system of choice such as operates in the United States. It provides an introductory picture of how people organise services and the variety of sources to which they go to fulfil their medical needs. Berkanovic and Reeder have pointed out that one can study use of medical services through examining the sources from which care Is received or the volume. 1 Much past research has focused on volume of care, emphasising amount of utilisation and number of physicians visits or outpatients visits. 2,3,4,5 The aim of this paper is to analyse sources of care and patterns of ambulatory medical care, not utilisation statistics. An important question is whether there are limitations of choice imposed by differential distribution of social characteristics such as knowledge, income or age. This paper first describes patterns of care‐seeking and then relates them to social, demographic and illness variables.