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Original Investigation
May 14, 2001

Assessing Use of Primary Health Care Services by Very Low-Income Adults in a Managed Care Program

Author Affiliations

From the Department of Medicine, Division of General Internal Medicine and Health Services Research (Drs Diamant, Brook, and Fink), Department of Medicine, Division of Geriatrics (Dr Brook), and Department of Family Medicine (Dr Gelberg), UCLA, Los Angeles, Calif; and RAND-Health, Santa Monica, Calif (Dr Brook).

Arch Intern Med. 2001;161(9):1222-1227. doi:10.1001/archinte.161.9.1222
Abstract

Objective  To assess the effect of providing free health care services to low-income adults.

Methods  We measured access to primary care services by enrollees with 4 chronic medical conditions in the General Relief Health Care Program (GRHCP), a program designed for adults receiving General Relief (GR). Implemented by the Los Angeles County Health Department in October 1995, the GRHCP is composed of private and public health care facilities. As adults registered for GR, they were asked to complete a baseline health survey, were enrolled in the GRHCP, and assigned a health care provider. A total of 8520 surveys were completed between September and November 1996 (98% response rate). The analyses of this article are limited to individuals (N = 2164) who reported a history of hypertension, diabetes mellitus, a nonresolving cough, or substance dependence. We reviewed medical records to determine whether new GR recipients had visited their designated GRHCP provider within 4 months of enrollment and used multivariate logistic regression to assess the effect of individual patient factors on the use of free health care.

Results  A total of 17% of individuals visited their assigned GRHCP provider within 4 months of enrollment. In multivariate analysis, patients were more likely to have made a visit if they were younger than 50 years, were female, were Asian/Pacific Islander, reported needing to see a physician, or had seen a physician within 12 months.

Conclusions  It is not sufficient to merely supply the name and address of a health care provider to this population. More aggressive efforts should be attempted to increase utilization of services for patients with medical conditions responsive to ambulatory care.

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