Access to primary care: the role of race and income

The study has two objectives: (1) to examine the racial differences in access provided by Municipal Health Services Clinics to the Medicare low-income beneficiaries, i.e., those also eligible for Medicaid (dual eligibles), and compare it with access provided to non-dually eligible patients; (2) to examine the racial and income disparities in access for primary and ancillary care services. The Municipal Health Services Program (MHSP) started in 1979 in five cities with the objective to improve access to primary care services. The study's method for measuring access combines use and need of care in a single index. The study finds that the clinics provided better access to dual eligibles than to non-dual eligibles and to nonwhite than to white dual eligibles. However, this was a result of higher use of ancillary services by the clinic nonwhite patients. This was particularly true in large clinics such as Baltimore, where inadequate targeting of the low-income group and higher ancillary use were more significant problems than racial disparity in access.