Patterns of hospital based ambulatory care

Abstract

Blue Cross/Blue Shield of Greater New York conducted a survey of ambulatory services in 135 hospitals during June 1974 encompassing 21 major clinics (accounting for the great majority of all patient visits) as well as Emergency Room services in each of the hospitals. A total of 16,822 patient visits were studied. The most striking variations in the characteristics of patients who made the visits to the 1120 clinics and 133 emergency rooms was the extraordinary utilization by minority groups and females. Blacks and Hispanics accounted for two out of every three visits as the clinic very clearly served as a surrogate for disappearing family physicians. Concentrated use of municipal hospital clinics by minorities was also confirmed. The dominance of young children and women was directly related to the high use of pediatrics, obstetrics, gynecology and allergy clinics. Utilization of the general medical and eye clinics were age related to the elderly; while services of the walk-in clinics were in demand by all ages over 15. As expected hospital clinics served a poor population of which three out of five were either welfare recipients or with very low incomes. Medicaid and out of pocket payments accounting for 73″ and almost equally divided, were the two major sources of payment for the survey visits. Medicare paid for an additional 14″. General examinations and check-ups, respiratory, ob-gyn, sensory conditions and circulatory ailments together accounted for over half of the visits. The study confirmed the thesis that lower income classes have a higher percent of chronic illness because of lack of preventive care and factors affecting life styles. The variation in district utilization rates explained by differences in ethnicity was found to exceed substantially that explained by per capita income, thus indicating that variation in clinic utilization is more closely associated with ethnicity than with income. As the growth of clinic utilization parallels the declining availability of the family physician in underserved areas so too does the use of the Emergency Rooms for non-trauma reasons reinforce this pattern. Non-white and low income patients comprised a high proportion of non-emergency cases because of lesser access to private physicians.