Patterns of physician use among low-income, chronically ill persons

The authors present new results from the 1978 National Health Interview Survey concerning the use of physician services by the least healthy segment of the low-income population: those who are limited in their activities due to chronic conditions. Poor and nonpoor persons with chronic activity limitations report similar levels of physician visits. However, lower-income persons report more severe chronic conditions and hence appear to use less physician care relative to their needs. In addition, low-income persons with chronic activity limitations report more visits in hospital outpatient clinics and emergency rooms and fewer in doctor's offices compared with others with such limitations, and they are more likely to report hospital outpatient departments as their usual source of care. Unfortunately, hospital-based ambulatory care is often more episodic and fragmented than care provided in other settings. The authors concluded that care for this population could be improved greatly by restructuring responsibility for the care of the chronically ill within hospital outpatient departments.