Ethnic differences in the outpatient use of a public-charity hospital.

Abstract

The differential use that is made of health services in contemporary American society, particularly by disadvantaged subgroups, is a topic not only of current interest but also of considerable concern. One or both of two general strategies, each having different advantages, disadvantages, and hence, purposes, can be used to examine patterns of health services use: Residents of a more or less bounded population segment may be sampled at one or several points in time and asked to report about use, or the records of key medical facilities and personnel that service the population of interest can be analyzed. In the study to be reported here we followed the second strategy and concentrated on a large public-charity hospital of a metropolitan area in the Southwestern United States. The purpose of this study is to explicate the differences in pattern of hospital use by the three principal ethnic groups of this area: Anglo-Americans, MexicanAmericans and Negro-Americans (hereafter referred to respectively as Anglos, Chicanos and blacks). There exists now a growing literature on the influence that ethnicity has on a variety of medically-relevant issues such as morbidity,' perception and expression of disability,24 lay systems of care,5 etc. There are relatively few studies comparing the use of health services by ethnic groups, however. Social factors that are associated with the use of specific units within a hospital have been documented (see for example 6 and 7). Studies that compare the way ethnic groups use different units within a hospital are needed, since this focus adds comprehensiveness to the interpretations that can be made about the way in which the respective ethnic groups obtain hospital-based medical care. In the study to be reported here the use of several outpatient units of a hospital were compared. Besides ethnic identification, attention is also given to other demographic variables (i.e., age and sex) that may help clarify the pattern of utilization by the ethnic groups. A second feature of the study reported here deserves attention, and that has to do with the properties of the medical care system that exists in the setting where the study was conducted. The area studied has few public-charity hospitals, and the one that was used as the study base constitutes the principal one. A very large portion of the universe that receives this type of medical care is consequently represented in the study sample. In addition, the bulk of the facilities and personnel that comprise the units of the medical care system of the city (including the public-charity hospital) are densely concentrated in one relatively small geographic setting, a setting which has little proximity to the population segments forced to use this type of medical care. Our study sample, then, in addition to encompassing a large representative portion of the economically disadvantaged health services consumer, also includes individuals who have overcome not inconsiderable geographic barriers in the pursuit of medical care.