The role of uninsurance and race in healthcare utilization by rural minorities.

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OBJECTIVE: To examine the independent effects of minority status, residence, insurance status, and income on physician utilization, controlling for general health status and the presence of acute or chronic health problems. Of special interest was the question of utilization differences among rural minority populations, as compared with urban non-Latino whites. DATA SOURCE: Data from the 1992 National Health Interview Survey (NHIS). STUDY DESIGN: Multivariate analyses used multiple logistic regression methods to detect independent effects of residence and minority status on whether or not individuals used physician services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from the National Health Interview Survey, 1992. The survey included information about the race/ethnicity of the respondent, health status, utilization of services, insurance status, and socioeconomic status. PRINCIPAL FINDINGS: The most salient determinant of utilization of healthcare services is insurance status, regardless of race/ethnicity or (rural or urban) place of residence. Racial and ethnic minorities were less likely than whites to use physician services, and use was generally lower for rural residents. The most striking differences were for rural Latinos and rural Asians/other persons. CONCLUSIONS: Although the results demonstrate a need to adjust policies designed to improve utilization by accounting for particular problems faced by minority populations, they also demonstrate the primacy of addressing financial access.

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