The Effect of Race, Insurance and Distance Upon the Utilization of Physician Services

This paper examines the relationships between the utilization of physician services and three variables — race, insurance, and distance to care — in a rural setting. Four measures of utilization are considered: (1) Total number of physician visits per capita during a twelve month period, (2) The percentage of persons in a given group having more than the mean number of physician visits per capita for that group, (3) The percentage of respondents having one or more physician visit during a twelve month period, and (4) The percentage of respondents having one or more physical examination during a twelve month period. The data reported were gathered as a part of a comprehensive community health survey. A fundamental result of this study is the discovery of a strong association between persons’ distance from their source of medical care and their utilization of physician services. While there is little relationship between distance and overall utilization, distance is apparently a very strong barrier to access to care and to preventive health care behavior. In addition, not having health insurance is significantly linked with lower utilization and Mexican-Americans appear less oriented to preventive care than white residents in the community studied. Four important methodological devices contribute to the significance of this study’s findings: (1) the use of several utilization measures, (2) a perceived-time measure of distance, (3) a threshold approach to analyzing distance effects, and (4) a normalization procedure that contributes a partial control for differential levels of need for health care.