Research
Findings #16: Patterns of Ambulatory Care Use: Changes from 1987
to 1996
James B. Kirby, Ph.D., Steven R. Machlin,
M.S., and Joshua M. Thorpe, M.P.H., Agency for Healthcare Research
and Quality
Abstract
The estimates in this report are based on the most recent data available
from MEPS at the time the report was written. However, selected elements
of MEPS data may be revised on the basis of additional analyses, which
could result in slightly different estimates from those shown here.
Please check the MEPS Web site for the most current file releases.
This report from the Agency for Healthcare Research and Quality (AHRQ)
presents trends in the use of ambulatory care services by the U.S.
population from 1987 to 1996. The authors examine the frequency with
which people visit health care providers by the setting of care (office,
hospital outpatient, or emergency room) and the reasons for visits
(prevention, diagnosis or treatment, or emergency), paying special
attention to differences between 1987 and 1996. They also examine
variation in trends across several variables, including age, race, sex,
urban versus rural residence, region, income, insurance status, and
health status. Data come from AHRQ’s 1987 National Medical Expenditure
Survey (NMES) and 1996 Medical Expenditure Panel Survey (MEPS). From
1987 to 1996, the percentage of visits that took place in outpatient
hospital settings and emergency rooms decreased, with a commensurate
increase in the percentage of total visits that took place in
office-based settings. The percentage of ambulatory care visits that
were for preventive reasons increased while the percentages for all
other types of visits decreased.
Introduction
This report examines trends in the use
of ambulatory care services by the U.S. civilian noninstitutionalized
population from 1987 to 1996. In addition to the frequency with
which people visit health care providers, we also examine whether
there have been significant shifts over the 9-year period in the
setting of care (office, hospital outpatient, or emergency room)
and the reasons for visits (prevention, diagnosis or treatment,
or emergency). We examine variation in trends across several variables,
including age, race, sex, urban versus rural residence, region,
income, insurance status, and health status. Our data come from
the 1987 National Medical Expenditure Survey (NMES) and the 1996
Medical Expenditure Panel Survey (MEPS). Each provides information
on one full year of health care use for the U.S. civilian noninstitutionalized
population.
Only differences that were statistically
significant at the 0.05 level are discussed in the text. A technical
appendix provides tables of standard errors, detailed information
on MEPS and NMES (including data collection methods, data editing,
and variable creation), and definitions of the terms used in this
report.
^top
Frequency of Visits
Table 1 presents the frequency of provider
visits by different population characteristics. Overall, there
was no substantial change from 1987 to 1996 in the percentage of
people who had at least one ambulatory care visit. In both years,
about three-quarters of the population had at least one visit.
Furthermore, among those who had at least one ambulatory visit,
there is little change in the average number of visits per person
from 1987 to 1996: about seven in both years.
Overall ambulatory care use changed
little from 1987 to 1996. However, there were some noteworthy changes
for people age 65 and over who were covered by Medicare only: 77
percent of them had at least one ambulatory care visit in 1987,
but by 1996, this figure had risen to 86 percent. In 1987, elderly
people covered exclusively by Medicare were substantially less
likely to have a visit than the elderly who had Medicare plus some
other health insurance, public or private. In contrast, by 1996,
those covered exclusively by Medicare were nearly as likely as
others to have an ambulatory visit.
^top
Visit Setting
From 1987 to 1996, the percent of
visits that took place in office-based settings increased.
Another important
component of health care service use is the setting in which
care is provided. Table
2 displays national estimates of the proportion of ambulatory care
visits that take place in three settings: a health care provider’s
office, a hospital outpatient department, and a hospital
emergency department. From 1987 to 1996, the percentage of visits
that took place in outpatient hospital settings and emergency rooms
decreased, with a commensurate increase in the percentage of total
visits that took place in office-based settings.
This change is apparent within all sociodemographic
groups examined in this report. The most pronounced changes, however,
are for blacks, the poor, and the publicly insured.
In 1987, nearly 20 percent of all visits
among blacks took place in outpatient hospital settings; in 1996,
the corresponding figure was only 11 percent.
Blacks also showed a more marked decline
than whites and Hispanics in the percentage of visits that took
place in emergency rooms. As a portion of all ambulatory care visits
by blacks, emergency rooms visits fell from 8 percent in 1987 to
5 percent in 1996.
The percentage of ambulatory care visits
occurring in hospital outpatient departments and emergency rooms
decreased more from 1987 to 1996 for people with lower incomes
than for those with higher incomes.
In 1987, over 15 percent of all ambulatory
care visits by people in the poorest income category were in outpatient
hospital settings, but by 1996 this figure declined to 10 percent.
In comparison, among those in the wealthiest income group, the
percentage of ambulatory care visits that took place in outpatient
hospital settings did not change significantly from 1987 to 1996.
The percentage of ambulatory care visits that took place in emergency
rooms also declined more for poor people from 1987 to 1996 than
for wealthier people. In 1987, 7 percent of all ambulatory care
visits by people in the lowest income category were to emergency
rooms; in 1996, only 5 percent of ambulatory care visits among
the poor were in emergency rooms. Although the proportion of ambulatory
care visits that took place in emergency rooms declined for other
income groups as well, the declines were smaller and some groups
showed no change across the period.
With respect to insurance status, the
increase in the proportion of ambulatory care visits in office-based
settings and decrease in the proportion of visits in hospital outpatient
and emergency departments are most pronounced for those with public
insurance. In 1987, 18 percent of ambulatory care visits for people
under age 65 who were insured exclusively by a public plan (mostly
Medicaid) were in hospital outpatient settings.
By 1996, however, this percentage had
declined by nearly half, to 9 percent. Similarly, there was a very
large decrease from 1987 to 1996 in the proportion of ambulatory
care visits that took place in outpatient hospital settings among
people age 65 and over who were insured exclusively by Medicare
or had Medicare plus supplemental public insurance. This decline
was particularly pronounced for the group with Medicare only, which
experienced a 50-percent reduction in the proportion of ambulatory
care visits that took place in outpatient hospital settings. In
contrast, the proportion of ambulatory visits to outpatient departments
remained fairly constant for both the non-elderly and elderly with
private health insurance.
As with outpatient departments, the
percentage of ambulatory care visits that took place in hospital
emergency rooms declined substantially for those with public insurance.
In 1987, people under 65 with only public insurance had 8 percent
of their ambulatory care visits in emergency rooms. By 1996, this
figure had declined to 5 percent. Among the elderly with Medicare
plus supplemental public insurance, the proportion of ambulatory
visits to emergency rooms declined from 5 percent to 3 percent.
Although not as large, there was also a significant decline in
the percentage of visits that took place in emergency rooms for
both elderly and non-elderly people with private insurance. It
should be noted, however, that the proportion of ambulatory care
visits to emergency rooms was much lower for privately insured
individuals than for other groups at both time points. The proportion
of visits that took place in emergency rooms did not change significantly
from 1987 to 1996 among the uninsured.
^top
Reason for Visit
The percent of ambulatory care visits
that were for preventive reasons increased from 1987 to 1996.
The final aspect of health care use
that we examine in this report is the reason for visits to health
care providers. Table 3 displays the distribution of ambulatory
care visits across four broad categories: visits for a general
checkups or other preventive services, visits for the diagnosis
or treatment of specific ailments, emergencies, and a residual
category. One general trend is evident from Table 3; the percentage
of ambulatory care visits that were for preventive reasons increased
from 1987 to 1996 while the percentages for all other types of
visits decreased. In 1987, 17 percent of all ambulatory care visits
were for preventive purposes; but by 1996, 23 percent of all visits
were preventive in nature.
Although preventive visits as a proportion
of all ambulatory care visits have increased across most sociodemographic
groups examined, the trend is particularly pronounced among individuals
in higher income groups. In 1987, only 16 percent of ambulatory
care visits among individuals in the wealthiest income category
were for preventive purposes, but by 1996, this figure had jumped
to 22 percent. For individuals in the poorest income groups, the
change was not significant.
The trend toward more preventive service
use is also more pronounced for children ages 6-17 than for people
in other age groups. In 1987, only 10.5 percent of ambulatory care
visits by children ages 6-17 were for preventive reasons, but by
1996, this figure had doubled to 21 percent.
Adults age 65 and over who were insured
exclusively by Medicare had a dramatic increase in the proportion
of ambulatory care visits that were for preventive reasons. In
1987, 20 percent of ambulatory care visits for people age 65 and
over who had Medicare and no supplemental insurance were for preventive
reasons; by 1996, 31 percent of their visits were for preventive
reasons.
^top
Summary and Conclusions
This report explored changes in ambulatory
care use from 1987 to 1996 in the civilian noninstitutionalized
population. Three aspects of health care use were examined: the
frequency with which individuals have ambulatory care visits, the
settings in which visits take place, and the reasons for visits.
We found that about three-quarters of the population had at least
one ambulatory care visit during the year in both 1987 and 1996.
However, other aspects of use changed. Among the most notable changes
are the following:
- Among people age 65 and over who
were covered exclusively by Medicare, the proportion with at
least one ambulatory care visit increased substantially from
1987 to 1996.
- During this time period, the proportion
of ambulatory care visits taking place in office-based settings
increased while the proportion of visits taking place in hospital
outpatient departments or emergency rooms decreased. This trend
was most evident for blacks, people in lower income categories,
and people with public health insurance.
- The proportion of ambulatory care
visits that were for preventive reasons increased, especially
among the higher income categories, children ages 6-17, and elderly
people insured exclusively by Medicare.
The findings discussed in this report
suggest that efforts on the part of health care organizations and
insurance companies during the late 1980s and 1990s to discourage
the use of hospital-based care and to encourage the use of preventive
care may have had some effect. It should be noted, however, that
these findings do not reflect changes in the pattern of health
care utilization that occurred after 1996.
^top
References
Edwards WS, Berlin M. Questionnaires
and data collection methods for the Household Survey and the Survey
of American Indians and Alaskan Natives. Rockville (MD): National
Center for Health Services Research and Health Care Technology
Assessment; 1989. National Medical Expenditure Survey Methods 2.
DHHS Pub. No. (PHS) 89-3450. Schappert SM. Ambulatory care visits
to physician offices, hospital outpatient departments, and emergency
departments: United States, 1996. National Center for Health Statistics;
1998. Vital Health Stat 13(134).
^top
Tables
Table 1. Ambulatory servicesa-
Total population, percent with any visit, and average number
of visits per person with visit: United States, 1987 and 1996
| |
1987 |
1996 |
| Population characteristic |
Total population (in thousands) |
Percent of U.S. population |
Percent with any visit |
Average number of visits for those with any |
Total population (in thousands |
Percent of U.S. population |
Percent with any visit |
Average number for those with any |
| |
Percent distribution |
Percent distribution |
| Total |
239,393
|
100 |
75.6 |
6.9 |
268,905 |
100.0 |
74.9 |
7.1 |
| Total
age in years |
|
|
|
|
|
|
|
|
| Under 6 |
22,133
|
9.3 |
85.8 |
5.3 |
23,861 |
8.9 |
85.0 |
4.5 |
| 6-17 |
41,616
|
17.4 |
70.0 |
4.8 |
47,634 |
17.7 |
68.6 |
4.0 |
| 18-44 |
102,117 |
42.7 |
70.7 |
6.6 |
109,149 |
40.6 |
68.6 |
6.7 |
| 45-64 |
45,232 |
18.9 |
78.9 |
8.1 |
54,212 |
20.2 |
79.1 |
8.9 |
| 65 and over |
28,295 |
11.8 |
88.3 |
9.7 |
34,050 |
12.7 |
89.5 |
10.5 |
| Race/ethnicity |
| White |
183,396 |
76.6 |
78.7 |
7.2 |
193,708 |
72.0 |
78.8 |
7.5 |
| Black |
28,567 |
11.9 |
66.6 |
5.9 |
33,668 |
12.5 |
65.3 |
5.7 |
| Hispanic |
19,186 |
8.0 |
64.6 |
5.2 |
29,979 |
11.2 |
63.3 |
6.0 |
| Other |
8,244 |
3.4 |
63.0 |
5.5 |
11,550 |
4.3 |
66.3 |
5.2 |
| Sex |
| Male |
115,861 |
48.4 |
70.1 |
6.3 |
131,527 |
48.9 |
69.2 |
6.4 |
| Female |
123,532 |
51.6 |
80.7 |
7.4 |
137,379 |
51.1 |
80.3 |
7.6 |
| Metropolitan statistical
area (MSA)b |
| MSA |
181,264 |
75.7 |
75.8 |
7.1 |
213,820 |
80.3 |
75.1 |
7.1 |
| Non-MSA |
58,129 |
24.3 |
75.0 |
6.4 |
52,443 |
19.7 |
74.1 |
7.0 |
| Census Region |
| Northeast |
47,539 |
19.9 |
77.4 |
7.4 |
51,965 |
19.3 |
77.4 |
7.7 |
| Midwest |
60,498 |
25.3 |
77.6 |
7.1 |
62,673 |
23.3 |
77.8 |
6.9 |
| South |
83,958 |
35.1 |
72.4 |
6.2 |
93,901 |
34.9 |
73.5 |
6.7 |
| West |
47,398 |
33.3 |
76.9 |
7.4 |
60,366 |
22.5 |
71.7 |
7.3 |
| Income |
| Poor |
31,187 |
13.1 |
70.6 |
6.6 |
38,298 |
14.2 |
70.8 |
7.6 |
| Near-poor |
10,882 |
4.6 |
72.8 |
6.8 |
12,946 |
4.8 |
71.4 |
7.1 |
| Low income |
33,290 |
14.0 |
72.7 |
7.0 |
40,460 |
15.1 |
70.2 |
6.7 |
| Middle income |
83,518 |
35.1 |
76.5 |
6.8 |
88,262 |
32.8 |
74.8 |
6.7 |
| High Income |
79,267 |
33.3 |
78.4 |
7.1 |
88,939 |
33.1 |
79.2 |
7.3 |
| Health insurance
statusb,d |
| Under 65
years |
|
|
|
|
|
|
|
|
| Any private |
164,232 |
68.8 |
76.7 |
6.5 |
174,231 |
64.8 |
76.3 |
6.4 |
| Public only |
22,738 |
9.5 |
75.7 |
7.7 |
27,845 |
10.4 |
76.1 |
8.0 |
| Uninsured |
24,128 |
10.1 |
53.1 |
4.8 |
32,780 |
12.2 |
51.1 |
4.9 |
| 65 years
and over |
|
|
|
|
|
|
|
|
| Medicare
only |
3,137 |
1.3 |
76.7 |
7.5 |
7,535 |
2.8 |
86.3 |
8.8 |
| Medicare
and private |
21,379 |
9.0 |
90.4 |
9.9 |
22,811 |
8.5 |
91.3 |
11.2 |
| Medicare
and other public |
2,946 |
1.2 |
91.6 |
10.8 |
3,555 |
1.3 |
88.2 |
10.2 |
| Perceived health
statusb |
| Excellent,
very good, or good |
174,918 |
82.9 |
74.0 |
6.1 |
239,088 |
89.5 |
73.3 |
6.2 |
| Fair or
poor |
36,043 |
17.1 |
85.8 |
10.9 |
28,125 |
10.5 |
89.8 |
13.6 |
a Ambulatory
services are visits to medical providers seen in office-based
settings or clinics, hospital outpatient departments, emergency
rooms (except visits resulting in an overnight hospital stay),
and clinics owned and operated by hospitals. Events
reported as hospital admissions without an overnight stay
are included.
b Numbers
of persons do not add to overall total because data on
this variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 2000 percent of
the poverty line; middle income, over 200 percent to 400
percent of the poverty line; and high income, over 400 percent
of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the period;
individuals with both public and private insurance and those
with CHAMPUS or CHAMPVA (Armed-Forces-related coverage) are
classified as having private insurance.
Note:
Restricted to civilian noninstitutionalized population. Percents
may not add to 100 because of rounding.
Source:
Center for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: National Medical Expenditure
Survey, 1987, and Medical Expenditure Panel Survey, 1996. |
Table
2. Ambulatory services a- Total number of visits and percent
distribution by setting: United States, 1987 and 1996
| |
1987 |
1996 |
| Population characteristic |
Total visits
(in millions) |
Office-
based |
Outpatient
department |
Emergency Room |
Total visits
(in millions) |
Office-
based |
Outpatient
department |
Emergency Room |
| |
Percent distribution |
Percent distribution |
| Total |
1,250.7 |
84.9 |
10.8 |
4.3 |
1,423.6 |
87.8 |
8.9 |
3.3 |
| Total
age in years |
|
|
|
|
|
|
|
|
| Under 6 |
101.0 |
85.4 |
7.7 |
6.8 |
91.1 |
90.2 |
4.5 |
5.3 |
| 6-17 |
140.7 |
87.0 |
7.0 |
5.9 |
131.2 |
90.0 |
4.6 |
5.4 |
| 18-44 |
475.9 |
86.0 |
9.4 |
4.6 |
498.4 |
89.1 |
7.0 |
3.9 |
| 45-64 |
290.0 |
84.1 |
12.9 |
3.0 |
381.5 |
86.7 |
11.1 |
2.1 |
| 65 and
over |
243.1 |
82.4 |
14.5 |
3.1 |
321.4 |
85.6 |
12.4 |
2.1 |
| Race/ethnicity |
| White |
1,046.4 |
86.3 |
9.9 |
3.8 |
1,146.4 |
88.0 |
9.1 |
3.0 |
| Black |
111.7 |
72.4 |
19.6 |
8.0 |
124.7 |
84.4 |
11.1 |
4.5 |
| Hispanic |
64.0 |
85.2 |
9.3 |
5.5 |
113.0 |
88.7 |
6.7 |
4.6 |
| Other |
28.7 |
82.4 |
12.4 |
5.2 |
39.6 |
91.6 |
5.0 |
3.5 |
| Sex |
| Male |
512.6 |
83.6 |
11.4 |
5.0 |
580.7 |
86.8 |
9.4 |
3.8 |
| Female |
738.1 |
85.8 |
10.4 |
3.8 |
842.9 |
88.5 |
8.6 |
2.9 |
| Metropolitan statistical
area (MSA)b |
| MSA |
973.6 |
84.9 |
11.1 |
4.0 |
1,139.9 |
88.6 |
9.4 |
3.8 |
| Non-MSA |
277.1 |
85.0 |
9.9 |
5.2 |
272.3 |
88.5 |
8.6 |
2.9 |
| Census Region |
| Northeast |
272.7 |
84.6 |
11.0 |
4.4 |
311.0 |
87.3 |
9.8 |
2.9 |
| Midwest |
333.1 |
84.9 |
11.3 |
3.9 |
334.6 |
84.7 |
11.3 |
4.0 |
| South |
376.2 |
84.0 |
10.9 |
5.1 |
462.3 |
88.8 |
7.8 |
3.4 |
| West |
268.8 |
86.6 |
9.9 |
3.5 |
315.7 |
90.1 |
7.3 |
2.6 |
| Income |
| Poor |
149.8 |
78.4 |
14.5 |
7.1 |
206.5 |
85.2 |
10.1 |
4.7 |
| Near-poor |
54.1 |
79.2 |
14.0 |
6.8 |
66.0 |
83.2 |
12.2 |
4.7 |
| Low income |
169.1 |
83.1 |
11.6 |
5.3 |
191.5 |
86.3 |
9.4 |
4.3 |
| Middle
income |
434.7 |
85.5 |
10.7 |
3.8 |
441.9 |
88.2 |
8.5 |
3.2 |
| High Income |
443.1 |
88.0 |
9.0 |
3.0 |
517.7 |
89.6 |
8.3 |
2.1 |
| Health insurance
statusb,d |
| Under 65
years |
|
|
|
|
|
|
|
|
| Any private |
814.2 |
87.6 |
8.5 |
3.9 |
849.8 |
89.2 |
7.8 |
3.0 |
| Public
only |
131.9 |
74.5 |
17.8 |
7.7 |
169.8 |
85.8 |
8.8 |
5.3 |
| Uninsured |
61.6 |
81.0 |
12.3 |
6.7 |
82.7 |
86.4 |
7.6 |
6.0 |
| 65 years
and over |
|
|
|
|
|
|
|
|
| Medicare
only |
18.1 |
71.0 |
25.2 |
3.8 |
57.2 |
85.1 |
12.6 |
2.3 |
| Medicare
and private |
191.6 |
84.1 |
13.1 |
2.8 |
232.3 |
85.4 |
12.6 |
1.9 |
| Medicare
and other public |
29.2 |
79.3 |
15.6 |
5.1 |
31.8 |
87.4 |
9.8 |
2.8 |
| Perceived
health statusb |
| Excellent,
very good, or good |
788.6 |
87.0 |
9.0 |
4.0 |
1,077.8 |
88.8 |
8.0 |
3.2 |
| Fair or
poor |
338.0 |
80.7 |
14.9 |
4.4 |
343.3 |
84.9 |
11.8 |
3.3 |
a Frequencies
and percentages regarding visits to medical providers seen
in office-based settings or clinics, hospital outpatient
departments, emergency rooms (except visits resulting in
an overnight hospital stay), and clinics owned and operated
by hospitals, as well as expenses for events reported as
hospital admissions without an overnight stay, are included.
b Numbers
of visits do not add to overall total because data on this
variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent of
the poverty line; middle income, over 200 percent to 400
percent of the poverty line; and high income, over 400 percent
of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the period;
individuals with both public and private insurance and those
with CHAMPUS or CHAMPVA (Armed-Forces-related coverage) are
classified as having private insurance.
Note:
Restricted to civilian noninstitutionalized population. Percents
may not add to 100 because of rounding.
Source:
Center for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: National Medical Expenditure
Survey, 1996. |
Table
3. Ambulatory services a-
Total number of visits and percent distribution by reason for
visit: United States, 1987 and 1996
| |
1987 |
1996 |
| Population characteristic |
Total visits
(in millions) |
Office-
based |
Outpatient
department |
Emergency Room |
Total visits
(in millions) |
Office-
based |
Outpatient
department |
Emergency Room |
| |
Percent distribution |
Percent distribution |
| Total |
1,250.7 |
84.9 |
10.8 |
4.3 |
1,423.6 |
87.8 |
8.9 |
3.3 |
| Total
age in years |
|
|
|
|
|
|
|
|
| Under 6 |
101.0 |
85.4 |
7.7 |
6.8 |
91.1 |
90.2 |
4.5 |
5.3 |
| 6-17 |
140.7 |
87.0 |
7.0 |
5.9 |
131.2 |
90.0 |
4.6 |
5.4 |
| 18-44 |
475.9 |
86.0 |
9.4 |
4.6 |
498.4 |
89.1 |
7.0 |
3.9 |
| 45-64 |
290.0 |
84.1 |
12.9 |
3.0 |
381.5 |
86.7 |
11.1 |
2.1 |
| 65 and
over |
243.1 |
82.4 |
14.5 |
3.1 |
321.4 |
85.6 |
12.4 |
2.1 |
| Race/ethnicity |
| White |
1,046.4 |
86.3 |
9.9 |
3.8 |
1,146.4 |
88.0 |
9.1 |
3.0 |
| Black |
111.7 |
72.4 |
19.6 |
8.0 |
124.7 |
84.4 |
11.1 |
4.5 |
| Hispanic |
64.0 |
85.2 |
9.3 |
5.5 |
113.0 |
88.7 |
6.7 |
4.6 |
| Other |
28.7 |
82.4 |
12.4 |
5.2 |
39.6 |
91.6 |
5.0 |
3.5 |
| Sex |
| Male |
512.6 |
83.6 |
11.4 |
5.0 |
580.7 |
86.8 |
9.4 |
3.8 |
| Female |
738.1 |
85.8 |
10.4 |
3.8 |
842.9 |
88.5 |
8.6 |
2.9 |
| Metropolitan statistical
area (MSA)b |
| MSA |
973.6 |
84.9 |
11.1 |
4.0 |
1,139.9 |
88.6 |
9.4 |
3.8 |
| Non-MSA |
277.1 |
85.0 |
9.9 |
5.2 |
272.3 |
88.5 |
8.6 |
2.9 |
| Census Region |
| Northeast |
272.7 |
84.6 |
11.0 |
4.4 |
311.0 |
87.3 |
9.8 |
2.9 |
| Midwest |
333.1 |
84.9 |
11.3 |
3.9 |
334.6 |
84.7 |
11.3 |
4.0 |
| South |
376.2 |
84.0 |
10.9 |
5.1 |
462.3 |
88.8 |
7.8 |
3.4 |
| West |
268.8 |
86.6 |
9.9 |
3.5 |
315.7 |
90.1 |
7.3 |
2.6 |
| Income |
| Poor |
149.8 |
78.4 |
14.5 |
7.1 |
206.5 |
85.2 |
10.1 |
4.7 |
| Near-poor |
54.1 |
79.2 |
14.0 |
6.8 |
66.0 |
83.2 |
12.2 |
4.7 |
| Low income |
169.1 |
83.1 |
11.6 |
5.3 |
191.5 |
86.3 |
9.4 |
4.3 |
| Middle
income |
434.7 |
85.5 |
10.7 |
3.8 |
441.9 |
88.2 |
8.5 |
3.2 |
| High Income |
443.1 |
88.0 |
9.0 |
3.0 |
517.7 |
89.6 |
8.3 |
2.1 |
| Health insurance
statusb,d |
| Under 65
years |
|
|
|
|
|
|
|
|
| Any private |
814.2 |
87.6 |
8.5 |
3.9 |
849.8 |
89.2 |
7.8 |
3.0 |
| Public
only |
131.9 |
74.5 |
17.8 |
7.7 |
169.8 |
85.8 |
8.8 |
5.3 |
| Uninsured |
61.6 |
81.0 |
12.3 |
6.7 |
82.7 |
86.4 |
7.6 |
6.0 |
| 65 years
and over |
|
|
|
|
|
|
|
|
| Medicare
only |
18.1 |
71.0 |
25.2 |
3.8 |
57.2 |
85.1 |
12.6 |
2.3 |
| Medicare
and private |
191.6 |
84.1 |
13.1 |
2.8 |
232.3 |
85.4 |
12.6 |
1.9 |
| Medicare
and other public |
29.2 |
79.3 |
15.6 |
5.1 |
31.8 |
87.4 |
9.8 |
2.8 |
| Perceived
health statusb |
| Excellent,
very good, or good |
788.6 |
87.0 |
9.0 |
4.0 |
1,077.8 |
88.8 |
8.0 |
3.2 |
| Fair or
poor |
338.0 |
80.7 |
14.9 |
4.4 |
343.3 |
84.9 |
11.8 |
3.3 |
a Frequencies
and percentages regarding visits to medical providers seen
in office-based settings or clinics, hospital outpatient
departments, emergency rooms (except visits resulting in
an overnight hospital stay), and clinics owned and operated
by hospitals, as well as expenses for events reported as
hospital admissions without an overnight stay, are included.
b Numbers
of visits do not add to overall total because data on this
variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent of
the poverty line; middle income, over 200 percent to 400
percent of the poverty line; and high income, over 400 percent
of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the period;
individuals with both public and private insurance and those
with CHAMPUS or CHAMPVA (Armed-Forces-related coverage) are
classified as having private insurance.
Note:
Restricted to civilian noninstitutionalized population. Percents
may not add to 100 because of rounding.
Source:
Center for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: National Medical Expenditure
Survey, 1996. |
^top
Appendix
The data in this report were obtained
in the first three rounds of interviews for the Household Component
(HC) of the 1996 Medical Expenditure Panel Survey (MEPS) and the
Household Survey of the 1987 National Medical Expenditure Survey
(NMES).
MEPS is cosponsored
by the Agency for Healthcare Research and Quality (AHRQ) and
the National Center
for Health Statistics (NCHS). NMES was sponsored by AHRQ’s
predecessor, the National Center for Health Services Research.
Both are nationally representative surveys of the U.S. civilian
noninstitutionalized population that collect medical expenditure
data at both the person and household levels. The focus of the
MEPS HC and the NMES Household Survey is to collect detailed data
on demographic characteristics, health conditions, health status,
use of medical care services, charges and payments, access to care,
satisfaction with care, health insurance coverage, income, and
employment.
The data in this report were obtained
in the first three rounds of interviews for the Household Component
(HC) of the 1996 Medical Expenditure Panel Survey (MEPS) and the
Household Survey of the 1987 National Medical Expenditure Survey
(NMES).
MEPS is cosponsored
by the Agency for Healthcare Research and Quality (AHRQ) and
the National Center
for Health Statistics (NCHS). NMES was sponsored by AHRQ’s
predecessor, the National Center for Health Services Research.
Both are nationally representative surveys of the U.S. civilian
noninstitutionalized population that collect medical expenditure
data at both the person and household levels. The focus of the
MEPS HC and the NMES Household Survey is to collect detailed data
on demographic characteristics, health conditions, health status,
use of medical care services, charges and payments, access to care,
satisfaction with care, health insurance coverage, income, and
employment.
Survey Design
1996 MEPS
The sample for the 1996 MEPS HC was
selected from respondents to the 1995 National Health Interview
Survey (NHIS), which was conducted by NCHS. NHIS provides a nationally
representative sample of the U.S. civilian noninstitutionalizied
population and reflects an oversampling of Hispanics and blacks.
The MEPS HC collects
data through an overlapping panel design. In this design, data
are collected
through a precontact interview that is followed by a series of
five rounds of interviews over 2 1 /2 years.
Interviews are conducted with one member of each family, who
reports on the health care experiences of the entire family.
Two calendar years of medical expenditure and utilization data
are collected from each household and captured using computer-assisted
personal interviewing (CAPI).
This series of data collection rounds
is launched again each subsequent year on a new sample of households
to provide overlapping panels of survey data that will produce
continuous and current estimates of health care expenditures. This
report uses Rounds 1-3 of the first MEPS panel to create utilization
estimates for calendar year 1996.
1987 NMES
The 1987 NMES was designed to provide
estimates of insurance coverage, use of services, expenditures,
and sources of payment for the period from January 1, 1987, through
December 31, 1987. The entire Household Survey was conducted in
four interview rounds at approximately 4-month intervals, with
a fifth short telephone interview at the end. Items related to
health status, access to health care, and income were collected
in special supplements that were administered over the course of
the calendar year. For more information on the survey instruments
and data collection methods for NMES, see Edwards and Berlin (1989).
Utilization Variables
The utilization variables used to derive
estimates for this report are based on the number of ambulatory
visits for health care that were reported as occurring in calendar
years 1987 (from NMES) and 1996 (from MEPS).
Visit Setting
For both 1987 and 1996 estimates, ambulatory
care events include visits to physician and nonphysician providers.
Dental visits, home health visits, and telephone contact with office-based
providers, regardless of provider type, are excluded from our estimates.
Examples of nonphysician providers include
chiropractors, physical and occupational therapists, nurses and
nurse practitioners, podiatrists, technicians, and receptionists,
clerks, or secretaries. All events are classified by the setting
in which they took place as follows: office visits, outpatient
hospital visits, and emergency room visits. Same-day hospital discharges
(hospital stays classified as inpatient that did not result in
an overnight stay) are treated as outpatient hospital visits.
It should
be noted that estimates of the number and proportion of visits
taking place in emergency rooms
based on MEPS are significantly lower than those based on the National
Ambulatory Medical Care Survey (NAMCS) and the National Hospital
Ambulatory Medical Care Survey (NHAMCS). MEPS is a household survey
of the civilian noninstitutionalized population, while NAMCS and
NHAMCS are provider-based surveys of doctors’offices and
hospitals, respectively. These surveys use different methodologies
in counting and classifying ambulatory visits. For estimates based
on NAMCS and NHAMCS, see Schappert (1998).
Reason for Visit
Both the NMES and MEPS questionnaires
asked respondents to report the main reason for visiting their
health care provider. Based on the responses, visits were classified
as follows:
- Preventive visits—For
both 1987 and 1996, office visits and outpatient hospital visits
were categorized as being for preventive purposes if respondents
said the visits were for a general checkup, maternity care,
well-child exam, or immunizations.
- Diagnosis or treatment—Because
questions were not identical in 1987 and 1996, edits were made
to ensure the greatest possible comparability. For 1987, office
visits and outpatient hospital visits were categorized as being
for diagnosis or treatment if respondents reported that the
main reason for the visit was diagnosis or treatment, psychotherapy,
reproductive services, foot care, physical or speech therapy,
or any diagnostic test (e.g., diagnostic imaging or lab tests).
For 1996, office visits and outpatient hospital visits were
categorized as being for diagnosis or treatment of a specific
ailment if respondents reported going to their provider for
diagnosis or treatment, psychotherapy, or postoperative services.
In addition, office visits and outpatient hospital visits were
categorized as being for diagnostic or treatment purposes if
a respondent indicated that one or more of the following services
were received: physical therapy, speech therapy, chemotherapy,
radiation therapy, kidney dialysis, intravenous therapy, drug
treatment, psychotherapy, or diagnostic imaging
- Emergency—Only
emergency room visits were categorized as being in the emergency
category. Although MEPS respondents could identify a visit
as being for emergency purposes regardless of the setting,
NMES did not allow this. To make the data from the two surveys
comparable, we considered all 1996 ambulatory care visits that
did not take place in an emergency room as non-emergencies
and assigned them to one of the other categories, as described
above.
- Other—This
residual category is made up of visits for which no reason
was ascertained, including responses of "don’t know" or "other" and
refusals.
Population Characteristics
Race/Ethnicity
Classification by race and ethnicity
is based on information reported for each household member. In
both MEPS and NMES, respondents were asked if their race was best
described as American Indian, Alaska Native, Asian or Pacific Islander,
black, white, or other.
In this report,
American Indians, Alaska Natives, Asians, and Pacific Islanders
are included in the "other" category.
Respondents in both surveys also were asked if each family member’s
main national origin or ancestry was Puerto Rican; Cuban, Mexican,
Mexicano, Mexican American, or Chicano; other Latin American; or
other Spanish. All persons whose main national origin or ancestry
was reported in one of these Hispanic groups, regardless of racial
background, were classified as Hispanic. Since the Hispanic grouping
can include black Hispanic, white Hispanic, and other Hispanic,
the race categories of white, black, and other do not include Hispanic
persons.
Income
Each sample
person was classified according to the total 1987 or 1996 income
of his or her family. Within a
household, all individuals related by blood, marriage, or adoption
were considered to be a family. Personal income from all family
members was summed to create family income. Possible sources of
income included annual earnings from wages, salaries, bonuses,
tips, and commissions; business and farm gains and losses; unemployment
and Worker’s Compensation; interest and dividends; alimony,
child support, and other private cash transfers; private pensions,
individual retirement account (IRA) withdrawals, Social Security,
and Department of Veterans Affairs payments; Supplemental Security
Income and cash welfare payments from public assistance, Aid to
Families with Dependent Children, and Aid to Dependent Children;
gains or losses from estates, trusts, partnerships, corporations,
rent, and royalties; and a small amount of "other" income.
Poverty status is the ratio of family
income to the 1987 or 1996 Federal poverty thresholds, which control
for family size and age of the head of family.
Categories are defined as follows:
- Poor—This
refers to persons in families with income less than or equal
to the poverty line and includes those who reported negative
income.
- Near-poor—This
group includes persons in families with income over the poverty
line through 125 percent of the poverty line.
- Low income—This
category includes persons in families with income over 125
percent through 200 percent of the poverty line.
- Middle income—This
category includes persons in families with income over 200
percent through 400 percent of the poverty line.
- High income—This
category includes persons in families with income over 400
percent of the poverty line.
Health Insurance Status
Individuals under age 65 were classified
into the following three insurance categories:
- Any private health insurance—Individuals
who, at any time during the year (1987 or 1996), had insurance
that provides coverage for hospital and physician care (other
than Medicare, Medicaid, or other public hospital/physician
coverage) are classified as having private insurance. Coverage
by CHAMPUS/CHAMPVA (Armed-Forces-related coverage) is also
included as private health insurance. Insurance that provides
coverage for a single service only, such as dental or vision
coverage, is not included.
- Public coverage only—Individuals
are considered to have public coverage only if they met both
of the following criteria: - They were not covered by
private insurance at any time during the year. - They were
covered by one of the following public programs at any point
during the year: Medicare, Medicaid, or other public hospital/physician
coverage.
- Uninsured—The
uninsured are defined as people not covered by Medicare, CHAMPUS/CHAMPVA,
Medicaid, other public hospital/physician programs, or private
hospital/physician insurance at any time during the entire
year or period of eligibility for the survey. Individuals covered
only by noncomprehensive State-specific programs (e.g., Maryland
Kidney Disease Program, Colorado Child Health Plan) or private
single-service plans (e.g., coverage for dental or vision care
only, coverage for accidents or specific diseases) are not
considered to be insured.
Individuals age 65 and over were classified
into the following three insurance categories:
- Medicare only.
- Medicare and private.
- Medicare and other public.
Perceived Health Status
The NMES questionnaire asked respondents
to rate the health of each person in the family according to the
following four categories: excellent, good, fair, and poor. The
MEPS questionnaire asked respondents to rate the health of each
person in the family according to the following five categories:
excellent, very good, good, fair, and poor. For the tables in this
report, these categories were collapsed into the following two
broad categories: (1) excellent, very good, or good health and
(2) fair or poor health.
Place of Residence
Individuals
are identified as residing either inside or outside a metropolitan
statistical area (MSA)
as designated by the U.S. Office of Management and Budget, which
applied 1990 standards using population counts from the 1990 U.S.
census. An MSA is a large population nucleus combined with adjacent
communities that have a high degree of economic and social integration
with the nucleus. Each MSA has one or more central counties containing
the area’s main population concentration. In New England,
metropolitan areas consist of cities and towns rather than whole
counties. MSA data are based on MSA status as of December 31, 1996.
If MSA status as of December 31 was not known, then MSA status
at the time of the Round 3 interview was used.
Region
Each MEPS sample person was classified
as living in one of the following four regions as defined by the
Bureau of the Census:
- Northeast
- Maine, New Hampshire, Vermont, Massachusetts, Rhode Island,
Connecticut,
New York, New Jersey, and Pennsylvania.
- Midwest
- Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota,
Iowa, Missouri,
North Dakota, South Dakota, Nebraska, and Kansas.
- South
- Delaware, Maryland, District of Columbia, Virginia, West
Virginia, North
Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee,
Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas.
- West
- Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah,
Nevada,
Washington, Oregon, California, Alaska, and Hawaii.
Rounding
Estimates presented in the tables were
rounded to the nearest 0.1 percent. Standard errors, presented
in tables A-C, were rounded to the nearest 0.01. Therefore, some
of the estimates for population totals of subgroups presented in
the tables will not add exactly to the overall estimated population
total.
Table
A. Standard errors for ambulatory servicesa - Total
population, percent with any visit, and average number of visits
per person with visit: United States, 1987 and 1996
| Population
characteristic |
1987 |
1996 |
Total
population (in thousands) |
Percent
of U.S. population |
Percent
with any visit |
Average
number of visits for those with any |
Total
population (in thousands) |
Percent
of U.S. population |
Percent
with any visit |
Average
number of visits for those with any |
| Total |
† |
-- |
0.4 |
0.1 |
† |
-- |
0.4 |
0.1 |
| Age in years |
| Under 6 |
† |
0.2 |
0.8 |
0.2 |
† |
0.3 |
1.1 |
0.1 |
| 6-17 |
† |
0.3 |
0.9 |
0.2 |
† |
0.4 |
1.0 |
0.1 |
| 18-44 |
† |
0.4 |
0.4 |
0.1 |
† |
0.5 |
0.6 |
0.2 |
| 45-64 |
† |
0.3 |
0.6 |
0.2 |
† |
0.4 |
0.7 |
0.3 |
| 65 and over |
† |
0.3 |
0.5 |
0.2 |
† |
0.4 |
0.7 |
0.3 |
| Race/ethnicity |
| White |
† |
1.1 |
0.4 |
0.1 |
† |
0.8 |
0.4 |
0.1 |
| Black |
† |
0.7 |
1.0 |
0.2 |
† |
0.7 |
1.2 |
0.3 |
| Hispanic |
† |
0.8 |
1.1 |
0.2 |
† |
0.6 |
1.1 |
0.6 |
| Other |
† |
0.5 |
2.0 |
0.4 |
† |
0.4 |
2.4 |
0.5 |
| Sex |
| Male |
† |
0.3 |
0.5 |
0.1 |
† |
0.3 |
0.6 |
0.2 |
| Female |
† |
0.3 |
0.4 |
0.1 |
† |
0.3 |
0.5 |
0.2 |
| Metropolitan statistical
area (MSA)b |
| MSA |
† |
1.5 |
0.4 |
0.1 |
† |
1.0 |
0.5 |
0.1 |
| Non-MSA |
† |
1.5 |
0.9 |
0.1 |
† |
1.0 |
1.0 |
0.3 |
| Census Region |
| Northeast |
† |
0.8 |
0.7 |
0.2 |
† |
0.8 |
1.0 |
0.3 |
| Midwest |
† |
0.8 |
0.7 |
0.2 |
† |
1.0 |
0.7 |
0.2 |
| South |
† |
0.8 |
0.6 |
0.1 |
† |
1.2 |
0.7 |
0.2 |
| West |
† |
0.9 |
0.7 |
0.3 |
† |
0.8 |
1.0 |
0.4 |
| Incomec |
| Poor |
† |
0.6 |
1.1 |
0.2 |
† |
0.5 |
1.0 |
0.5 |
| Near-poor |
† |
0.3 |
1.4 |
0.3 |
† |
0.3 |
1.8 |
0.7 |
| Low income |
† |
0.4 |
0.9 |
0.2 |
† |
0.5 |
1.1 |
0.2 |
| Middle income |
† |
0.6 |
0.6 |
0.2 |
† |
0.7 |
0.7 |
0.2 |
| High income |
† |
0.7 |
0.5 |
0.2 |
† |
0.9 |
0.7 |
0.2 |
| Health insurance
statusb,d |
| Under 65 years |
|
|
|
|
|
|
|
|
| Any private |
2,760 |
0.8 |
0.4 |
0.1 |
4,618 |
0.8 |
0.5 |
0.1 |
| Public only |
1,286 |
0.5 |
1.0 |
0.1 |
1,401 |
0.5 |
1.1 |
0.7 |
| Uninsured |
1,045 |
0.4 |
1.1 |
0.4 |
1,394 |
0.4 |
1.3 |
0.3 |
| 65 years and over |
|
|
|
|
|
|
|
|
| Medicare only |
165 |
0.1 |
1.7 |
0.7 |
480 |
0.2 |
1.7 |
0.6 |
| Medicare and private |
748 |
0.3 |
0.5 |
0.3 |
906 |
0.3 |
0.8 |
0.4 |
| Medicare and other
public |
244 |
0.1 |
1.3 |
0.6 |
271 |
0.1 |
2.0 |
1.0 |
| Perceived health
statusb |
| Excellent, very good,
or good |
2,428 |
0.4 |
0.4 |
0.1 |
5,371 |
0.3 |
0.4 |
0.1 |
| Fair or poor |
970 |
0.4 |
0.7 |
0.3 |
978 |
0.3 |
0.8 |
0.6 |
| a Ambulatory
services are visits to medical providers seen in office-
based settings or clinics, hospital outpatient departments,
emergency rooms (except visits resulting in an overnight
hospital stay), and clinics owned and operated by hospitals,
as well as expenses for events reported as hospital admissions
without an overnight stay, are included.
b Data
on this variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-
poor, over the poverty line through 125 percent of the
poverty line; low income, over 125 percent through 200
percent of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income, over
400 percent of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the
period; individuals with both public and private insurance
and those with CHAMPUS or CHAMPVA (Armed- Forces- related
coverage) are classified as having private insurance.
†Standard
error approximately zero because of poststratification to
Census Bureau population control tables.
Note: Restricted
to civilian noninstitutionalized population.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: National Medical Expenditure Survey,
1987, and Medical Expenditure Panel Survey, 1996. |
Table
B. Standard errors for ambulatory servicesa - Total
number of visits and percent distribution by setting:
United States, 1987 and 1996
| Population
characteristic |
1987 |
1996 |
Total
visits (in millions) |
Office-based |
Outpatient
department |
Emergency
room |
Total
visits (in millions) |
Office-based |
Outpatient
department |
Emergency
room |
| Total |
23.4 |
0.5 |
0.4 |
0.1 |
39.7 |
0.4 |
0.4 |
0.1 |
| Age in years |
| Under 6 |
5.0 |
1.2 |
0.9 |
0.4 |
4.6 |
0.6 |
0.5 |
0.3 |
| 6-17 |
6.7 |
0.8 |
0.7 |
0.3 |
6.3 |
0.7 |
0.6 |
0.3 |
| 18-44 |
13.1 |
0.6 |
0.5 |
0.2 |
23.2 |
0.6 |
0.5 |
0.2 |
| 45-64 |
9.7 |
0.9 |
0.9 |
0.1 |
16.1 |
0.8 |
0.8 |
0.1 |
| 65 and over |
9.0 |
1.0 |
0.9 |
0.1 |
15.1 |
1.0 |
1.0 |
0.1 |
| Race/ethnicity |
| White |
23.6 |
0.5 |
0.4 |
0.1 |
34.1 |
0.4 |
0.4 |
0.1 |
| Black |
7.5 |
1.8 |
1.8 |
0.5 |
10.2 |
1.7 |
1.8 |
0.4 |
| Hispanic |
6.0 |
1.2 |
1.0 |
0.4 |
11.9 |
1.3 |
1.0 |
0.5 |
| Other |
4.7 |
2.4 |
2.4 |
0.7 |
5.6 |
1.5 |
1.0 |
0.7 |
| Sex |
| Male |
13.3 |
0.6 |
0.6 |
0.2 |
21.2 |
0.6 |
0.6 |
0.2 |
| Female |
15.3 |
0.6 |
0.5 |
0.1 |
24.5 |
0.5 |
0.5 |
0.1 |
| Metropolitan statistical
area (MSA)b |
| MSA |
30.2 |
0.6 |
0.5 |
0.1 |
33.8 |
0.4 |
0.4 |
0.1 |
| Non-MSA |
15.8 |
0.9 |
0.8 |
0.3 |
21.6 |
1.4 |
1.3 |
0.3 |
| Census Region |
| Northeast |
16.1 |
0.8 |
0.7 |
0.2 |
15.7 |
0.7 |
0.6 |
0.2 |
| Midwest |
11.6 |
0.8 |
0.7 |
0.2 |
18.1 |
0.9 |
0.9 |
0.2 |
| South |
11.7 |
1.0 |
1.0 |
0.2 |
24.0 |
0.7 |
0.7 |
0.2 |
| West |
15.7 |
1.0 |
1.0 |
0.2 |
21.2 |
0.9 |
0.8 |
0.2 |
| Incomec |
| Poor |
8.3 |
1.4 |
1.2 |
0.5 |
16.3 |
1.4 |
1.3 |
0.4 |
| Near-poor |
3.8 |
1.7 |
1.5 |
0.6 |
6.9 |
3.1 |
3.2 |
0.7 |
| Low income |
8.2 |
0.9 |
0.9 |
0.3 |
10.1 |
1.0 |
1.0 |
0.3 |
| Middle income |
13.9 |
0.6 |
0.6 |
0.1 |
17.2 |
0.5 |
0.5 |
0.2 |
| High income |
13.9 |
0.5 |
0.5 |
0.1 |
21.8 |
0.6 |
0.5 |
0.1 |
| Health insurance
statusb,d |
| Under 65 years |
|
|
|
|
|
|
|
|
| Any private |
21.5 |
0.4 |
0.4 |
0.1 |
28.2 |
0.4 |
0.4 |
0.1 |
| Public only |
8.8 |
1.9 |
1.7 |
0.5 |
16.9 |
1.4 |
1.1 |
0.6 |
| Uninsured |
4.0 |
1.6 |
1.5 |
0.5 |
6.4 |
1.4 |
1.2 |
0.6 |
| 65 years and over |
|
|
|
|
|
|
|
|
| Medicare only |
2.0 |
5.8 |
6.1 |
0.5 |
5.3 |
3.4 |
3.5 |
0.3 |
| Medicare and private |
8.2 |
0.9 |
0.9 |
0.1 |
13.0 |
1.1 |
1.1 |
0.2 |
| Medicare and other
public |
2.9 |
2.5 |
2.5 |
0.4 |
4.0 |
2.4 |
2.4 |
0.5 |
| Perceived health
statusb |
| Excellent, very good,
or good |
18.5 |
0.5 |
0.4 |
0.1 |
30.4 |
0.4 |
0.4 |
0.1 |
| Fair or poor |
11.5 |
0.9 |
0.9 |
0.2 |
18.9 |
1.0 |
1.0 |
0.2 |
|
a Frequencies
and percentages regarding visits to medical providers seen
in office- based settings or clinics, hospital outpatient
departments, emergency rooms (except visits resulting in
an overnight hospital stay), and clinics owned and operated
by hospitals, as well as expenses for events reported as
hospital admissions without an overnight stay, are included.
b Data
on this variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-
poor, over the poverty line through 125 percent of the
poverty line; low income, over 125 percent through 200
percent of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income, over
400 percent of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the
period; individuals with both public and private insurance
and those with CHAMPUS or CHAMPVA (Armed- Forces- related
coverage) are classified as having private insurance.
†Standard
error approximately zero because of poststratification to
Census Bureau population control tables.
Note: Restricted
to civilian noninstitutionalized population.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: National Medical Expenditure Survey,
1987, and Medical Expenditure Panel Survey, 1996. |
Table C. Standard errors for ambulatory servicesa -
Total number of visits and percent distribution by
reason for visit: United States, 1987 and 1996
| Population
characteristic |
1987 |
1996 |
Total
visits (in millions) |
Preventive
services |
Diagnosis
and/or treatment |
Emergency |
Other |
Total
visits (in millions) |
Preventive
services |
Diagnosis
and/or treatment |
Emergency |
Other |
| Total |
23.4 |
0.4 |
0.5 |
0.1 |
0.3 |
39.7 |
0.5 |
0.6 |
0.1 |
0.4 |
| Age in years |
| Under 6 |
5.0 |
1.2 |
1.3 |
0.4 |
0.8 |
4.6 |
1.1 |
1.2 |
0.3 |
0.2 |
| 6-17 |
6.7 |
0.6 |
1.1 |
0.3 |
1.2 |
6.3 |
1.1 |
1.4 |
0.3 |
1.0 |
| 18-44 |
13.1 |
0.5 |
0.7 |
0.2 |
0.4 |
23.2 |
0.9 |
1.1 |
0.2 |
0.5 |
| 45-64 |
9.7 |
0.6 |
0.7 |
0.1 |
0.6 |
16.1 |
0.7 |
1.0 |
0.1 |
0.9 |
| 65 and over |
9.0 |
0.7 |
0.8 |
0.1 |
0.5 |
15.1 |
0.8 |
1.0 |
0.1 |
0.5 |
| Race/ethnicity |
| White |
23.6 |
0.4 |
0.5 |
0.1 |
0.4 |
34.1 |
0.5 |
0.7 |
0.1 |
0.4 |
| Black |
7.5 |
1.0 |
1.4 |
0.5 |
0.6 |
10.2 |
1.4 |
1.8 |
0.4 |
1.5 |
| Hispanic |
6.0 |
1.3 |
1.5 |
0.4 |
0.9 |
11.9 |
2.4 |
3.2 |
0.5 |
0.6 |
| Other |
4.7 |
1.7 |
1.7 |
0.7 |
1.5 |
5.6 |
2.8 |
3.5 |
0.7 |
0.9 |
| Sex |
| Male |
13.3 |
0.4 |
0.7 |
0.2 |
0.6 |
21.2 |
0.7 |
0.9 |
0.2 |
0.4 |
| Female |
15.3 |
0.4 |
0.5 |
0.1 |
0.3 |
24.5 |
0.6 |
0.7 |
0.1 |
0.5 |
| Metropolitan statistical
area (MSA)b |
| MSA |
30.2 |
0.4 |
0.6 |
0.1 |
0.4 |
33.8 |
0.5 |
0.7 |
0.1 |
0.4 |
| Non-MSA |
15.8 |
0.8 |
0.9 |
0.3 |
0.5 |
21.6 |
1.3 |
1.5 |
0.3 |
0.6 |
| Census Region |
| Northeast |
16.1 |
1.0 |
1.5 |
0.2 |
1.0 |
15.7 |
1.0 |
1.5 |
0.2 |
1.3 |
| Midwest |
11.6 |
0.7 |
0.7 |
0.2 |
0.4 |
18.1 |
0.9 |
1.0 |
0.2 |
0.4 |
| South |
11.7 |
0.6 |
0.8 |
0.2 |
0.6 |
24.0 |
0.7 |
0.9 |
0.2 |
0.4 |
| West |
15.7 |
0.6 |
0.5 |
0.2 |
0.5 |
21.2 |
1.2 |
1.5 |
0.2 |
0.8 |
| Incomec |
| Poor |
8.3 |
1.0 |
1.4 |
0.5 |
0.8 |
16.3 |
1.7 |
2.4 |
0.4 |
1.7 |
| Near-poor |
3.8 |
1.4 |
1.8 |
0.6 |
1.2 |
6.9 |
2.2 |
3.2 |
0.7 |
1.7 |
| Low income |
8.2 |
0.8 |
1.0 |
0.3 |
0.9 |
10.1 |
1.1 |
1.3 |
0.3 |
0.7 |
| Middle income |
13.9 |
0.5 |
0.6 |
0.1 |
0.4 |
17.2 |
0.7 |
0.9 |
0.2 |
0.5 |
| High income |
13.9 |
0.6 |
0.7 |
0.1 |
0.4 |
21.8 |
0.7 |
0.8 |
0.1 |
0.5 |
| Health insurance
statusb,d |
| Under 65 years |
|
|
|
|
|
|
|
|
|
|
| Any private |
21.5 |
0.5 |
0.6 |
0.1 |
0.4 |
28.2 |
0.5 |
0.6 |
0.1 |
0.4 |
| Public only |
8.8 |
1.2 |
1.6 |
0.5 |
0.5 |
16.9 |
2.2 |
3.1 |
0.6 |
2.0 |
| Uninsured |
4.0 |
1.2 |
1.8 |
0.5 |
1.4 |
6.4 |
1.2 |
1.8 |
0.6 |
1.2 |
| 65 years and over |
|
|
|
|
|
|
|
|
|
|
| Medicare only |
2.0 |
2.2 |
2.9 |
0.5 |
1.4 |
5.3 |
1.7 |
1.9 |
0.3 |
1.0 |
| Medicare and private |
8.2 |
0.7 |
0.8 |
0.1 |
0.4 |
13.0 |
0.9 |
1.2 |
0.2 |
0.7 |
| Medicare and other
public |
2.9 |
1.8 |
2.6 |
0.5 |
2.3 |
4.0 |
3.4 |
4.0 |
0.5 |
0.7 |
| Perceived health
statusb |
| Excellent, very good,
or good |
18.5 |
0.4 |
0.6 |
0.1 |
0.4 |
30.4 |
0.5 |
0.6 |
0.1 |
0.3 |
| Fair or poor |
11.5 |
0.6 |
0.7 |
0.2 |
0.5 |
18.9 |
1.0 |
1.5 |
0.2 |
1.1 |
|
a Frequencies
and percentages regarding visits to medical providers seen
in office- based settings or clinics, hospital outpatient
departments, emergency rooms (except visits resulting in
an overnight hospital stay), and clinics owned and operated
by hospitals, as well as expenses for events reported as
hospital admissions without an overnight stay, are included.
b Data
on this variable were not available for some sample persons.
c Poor
refers to incomes below the Federal poverty line; near-
poor, over the poverty line through 125 percent of the
poverty line; low income, over 125 percent through 200
percent of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income, over
400 percent of the poverty line.
d Uninsured
refers to persons uninsured during the entire year. Public
and private health insurance categories refer to individuals
with public or private insurance at any time during the
period; individuals with both public and private insurance
and those with CHAMPUS or CHAMPVA (Armed- Forces- related
coverage) are classified as having private insurance.
Note: Restricted
to civilian noninstitutionalized population.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: National Medical Expenditure Survey,
1987, and Medical Expenditure Panel Survey, 1996. |
^top
Suggested Citation:
Kirby, J. B., Machlin, S. R., and
Thorpe, J. M. Research Findings #16: Patterns of Ambulatory
Care Use: Changes from 1987 to 1996. July 2001. Agency for
Healthcare Research and Quality, Rockville, MD.
http://www.meps.ahrq.gov/data_files/publications/rf16/rf16.shtml |
|
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