Preventive Medicine 30, 453–462 (2000) doi:10.1006/pmed.2000.0672, available online at http://www.idealibrary.com on Health Risks, Ability to Pay, and the Use of Primary Care: Is the Distribution of Service Effective and Equitable? Robert W. Broyles, Ph.D.,* Lutchmie Narine, Ph.D.,* , † ,1 Edward N. Brandt, Jr., M.D., Ph.D.,* and Diane Biard-Holmes, MSW* *Department of Health Administration and Policy and †Center for Family Medicine Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190 of concern from at least three standpoints. First and Background. This study clarifies the confusion about most important is that a number of changes in arrange- what factors are consistent predictors of primary care ments of both the delivery and the financing of care service use, of which preventive services are a major within the Medicaid and Medicare programs could be component. A variety of health risk, predisposing, and deleterious to the use of primary care by the medically enabling characteristics were assessed for their associ- vulnerable. Second, contemporary research on pre- ation with the use of primary care. Variable selection dictors of primary care service use have not kept pace was guided by the use of the Andersen–Newman Be- with that of the growing literature on predictors of phy- havioral Model of health service utilization. sician utilization in general or that of hospital use [1]. Methods. The responses of 1512 residents of Okla- For example, in many instances it is assumed that indi- homa to the BRFS survey were used in this study. Both cators of general physician or hospital use are similar probit and logistic analyses were used to assess the use to those for preventive services. Third, previous work of nine preventive services and a summary index of identifying indicators of primary care utilization tends service use. to neglect the guidance of analytic models that provide Results. The results indicate that those at greater risk of illness and least able to use finance services a theoretical context for the choice of variables selected have the lowest rates of use among the nine preventive for study or the interpretation of findings [2–7]. Analyt- services individually and when combined as an index ically based research would enhance the generalizabil- of overall primary care use. ity of findings and provide opportunities for advance- Conclusions. Problems persist with the adequate dis- ment in the conceptual understanding of primary care tribution of primary care among the medically vulner- access issues faced by the patient population. As well, able. Furthermore, recent welfare and health reforms each study focuses on differing measures of primary may present added obstacles to their access to quality care services, thus it is unclear whether identified pre- primary care services. The paper concludes with a dis- dictors are specific to the particular service studied or cussion of policy options that may improve the effec- applicable to other services [3,8–13]. This, in turn, tiveness of primary care and redress inequities in the makes it difficult to generalize about the factors affect- use of these services.  2000 American Health Foundation and ing the distribution and use of primary care services. Academic Press More systematic research which seeks to clarify the Key Words: preventive services; primary care; equity; confusion about what factors are indeed consistent pre- medically vulnerable. dictors of primary care service use is very much needed since it is widely believed that the appropriate use of INTRODUCTION primary care, of which preventive services are a major component, results in the early diagnosis of illness, im- The issue of the distribution and use of primary care, proves future health status, lowers the future use of of which preventive services are a major component, is therapeutic procedures, and ultimately reduces re- lated costs. 1 To whom reprint requests should be addressed at Department of In order to address these deficiencies of previous re- Health Administration and Policy, College of Public Health, Post search, this study had the following four objectives: (i) Office Box 26901, Oklahoma City, Oklahoma 73190. Fax: (405) 271- 1868, E-mail: Lutchmie-Narine@ouhsc.edu. seek to identify indicators and predictors of preventive 453 0091-7435/00 $35.00 Copyright  2000 by American Health Foundation and Academic Press All rights of reproduction in any form reserved.