ACCESS TO AND UTILIZATION OF PRIMARY MEDICAL SERVICES: A SYNTHESIS OF COMPETING APPROACHES

MICHAEL JOSEPH JERIN, Purdue University

Abstract

The major problem addressed deals with an attempt to resolve the disagreement found in the literature relative to the access to and use of medical care services. It is argued that some of the principal causes of this problem lie in the complexity of access and use phenomena themselves, and also in the practice of approaching them from either an exclusively structural or social psychological explanatory perspective. It is postulated that through the use of a theoretical approach which incorporates both structural and social psychological factors that some resolution of the differences in the literature might be obtained. The synthetic framework developed for this research hypothesizes the use of medical services to result from a process in which the interactions of both structural and social psychological factors play a major role. Within this context, social psychological factors are posited to intervene between structural determinants and actual use. Path analysis is used to examine data collected on 746 respondents residing in a medium-sized midwestern community. Listwise deletion of cases containing missing data was employed resulting in a final sample size in the analysis of 676 cases. The findings indicate that access to medical care is determined solely by sex and income. The synthetic approach did not appear valid when applied to overall use of medical services by respondents. However, when the use of preventive health care services was examined the findings indicate that a synthetic approach is viable, as the use of preventive health care services was found to be an extremely complex process in which social psychological variables intervene to some extent between use and the antecedent structural and demographic variables in the model.

Degree

Ph.D.

Subject Area

Sociology

COinS