Although evidence is strong that populations with poor socioeconomic position have worse health status, little is known about patterns of outpatient health care use among the poor. This Small Grant proposal is to investigate whether outpatient health care use is greater among poorer compared to wealthier adults who have both insurance and a usual source of care. We will examine this relation overall and for three prevalent outpatient medical conditions: non-insulin dependent diabetes, affective and anxiety disorders, and hypertension. In this proposed one- year research project, we will conduct secondary analyses of the Medical Expenditure Panel Survey Household Component [MEPS-HC] to quantify the relation between socioeconomic position and outpatient health care resource use among persons with access to health care. The MEPS-HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data at both the person and household levels. We estimate that 8,240 persons 18 to 64 years with access to health care will be eligible for the study. Analyses will be stratified by age, gender, race/ethnicity, and health status whenever sample sizes are sufficient.
Specific Aims are: 1) To describe socioeconomic position [as defined by household income, occupation, educational attainment, insurance type] in relation to age, gender, and race/ethnicity; 2) To quantify associations between socioeconomic position and two intermediary variables that may affect utilization in the total sample and within disease subgroups: non-insulin dependent diabetes; affective and anxiety disorders, and hypertension. These intermediary variables are health status, and social factors contributing to illness burden defined by caregiving responsibilities and social support; and 3) To quantify associations for health care use in relation to socioeconomic position, overall, and among people with non-insulin dependent diabetes, anxiety and affective disorders, and hypertension, in the following categories of health care use: use of outpatient physician ancillary staff; and use of urgent care facilities. By quantifying greater utilization demands on health care providers and institutions who disproportionately serve poor adults relative to those with adequate social and economic resources, the proposed research will assess the need for differential reimbursement plans as a function of person-time use of outpatient services.
