Skip to main content
SpringerLink
Log in

Utilization of ambulatory care studies: testing the assumptions

  • Published:
Quality and Quantity Aims and scope Submit manuscript

Abstract

A linear regression procedure is usually used to estimate the effect of a set of predictors on utilization of ambulatory health care. The implicit assumptions embedded in the linear regression model have never been examined. Here, with utilization data of a sample of 48292 patients from the file of the Québec National Health Plan, four implicit hypotheses embedded in the linear regression model are tested: (1) the transition from the state of utilization to the state of no utilization, and vice-versa, depends on the level of the transition rates, (2) the effect of independent variables depends on the transitions being predicted from or to the state of utilization, (3) the transition is time dependent, and (4) the system of transitions from one state to another is not at equilibrium. The analysis shows that the first three hypotheses cannot be rejected. Thus, the use of the familiar linear regression procedure in this study to estimate the effect of a set of factors on utilization would have yielded biased estimates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • AndersenA.S. & LaakeP. (1983). “A causal model for physician utilization: Analysis of Norwegian data”, Medical Care 21: 266–278.

    Google Scholar 

  • BerkanovicE., TeleskyC. & ReederS. (1981). “Structural and psychological factors in the decision to seek medical care for symptoms”, Medical Care 19: 693–709.

    Google Scholar 

  • BroylesR., MangaP., BinderD.A., AngusD.E. & CharetteA.. (1983). “The use of physician services under a national health insurance scheme: An examination of the Canada health survey”, Medical Care 23: 1037–1054.

    Google Scholar 

  • ClearyP.D., MechanicD. & GreenleyJ.R. (1982). “Sex differences in medical care utilization: An empirical investigation”, Journal of Health and Social Behavior 23: 106–108.

    Google Scholar 

  • ColemanJ.S. (1981). Longitudinal Data Analysis. New York: Basic Books.

    Google Scholar 

  • DiehrP., MartinD.P., PriceK.F., FriedlanderL.J., RichardsonW.C. & RiedelD.C. (1984). “Use of ambulatory services in three provider plans: Interactions between patient characteristics and plans”, American Journal of Public Health 74: 47–51.

    Google Scholar 

  • DuttonD.B. (1978). “Explaining the low use of health services by the poor: Costs, attitudes, or delivery systems?”, American Sociological Review 43: 348–368.

    Google Scholar 

  • EricksonE.A. & MattsonL.G. (1983). “Quantitative measurement of continuity of care”. Medical Care 21: 858–875.

    Google Scholar 

  • EvashwickC., RoweG., DiehrP. & BranchL. (1984). “Factors explaining the use of health care services by the elderly”, Health Services Research 19: 357–382.

    Google Scholar 

  • HersheyJ.C., LuftH.S. & GianarisJ.M. (1975). “Making sense out of utilization data”, Medical Care 13: 838–864.

    Google Scholar 

  • HulkaB.S., KupperL.L. & CasselJ.C. (1972). “Determinants of physician utilization: Approach to a service-oriented classification of symptoms”, Medical Care 10: 300–309.

    Google Scholar 

  • InghamJ.G. & MillerP.M. (1983). “Self-referral: Social and demographic determinants of consulting behavior”, Journal of Psychosomatic Research 27: 233–243.

    Google Scholar 

  • KilpatrickS.J. (1977a). “Consultation frequencies in general practice”, Health Services Research 12: 284–298.

    Google Scholar 

  • Kilpatrick, S.J. (1977b). “An empirical study of the distribution of episodes of illness”, Journal of the Royal Statistical Society 26: Part I.

  • KuderJ.M. & LevitzG.S. (1985). “Visits to the physician: An evaluation of the usual service effect”, Health Services Research 20: 579–596.

    Google Scholar 

  • LinkC.R., LongS.H. & SettleR.F. (1982). “Access to medical care under Medicaid: Differentials by race”, Journal of Health Politics, Policy and Law 7: 345–365.

    Google Scholar 

  • McCallM. & WayH.S. (1983). “An analysis of the use of medicare services by the continuously enrolled aged”, Medical Care 21: 567–585.

    Google Scholar 

  • MarkidesK., LevinJ.S. & RayL.A. (1985). “Determinans of physician utilization among Mexican Americans: A three generation study”, Medical Care 23: 236–246.

    Google Scholar 

  • PopeC.R. (1982). “Life styles, health status, and medical utilization”, Medical Care 20: 402–413.

    Google Scholar 

  • RoosN.P. & ShapiroE. (1981). “The Manitoba longitudinal study on aging: Preliminary findings on health care utilization by the elderly”, Medical Care 19: 644–657.

    Google Scholar 

  • RoosN.P., ShapiroE. & RoosL.L. (1984). “Aging and the demand for health services: Which aged and whose demand?”, The Gerontologist 24: 31–36.

    Google Scholar 

  • RundallT.G. & WheelerJ.R.C. (1979). “The effect of income on use of preventive care: An evaluation of alternatives”, Journal of Health and Social Behavior 20: 397–406.

    Google Scholar 

  • ShapiroE. & RoosN.P. (1985). “Elderly nonusers of health care services: Their characteristics and their health outcome”, Medical Care 23: 247–257.

    Google Scholar 

  • SharpK., RossC.E. & CockerhamW.C. (1983). “Symptoms, beliefs, and the use of physician services among the disadvantaged”, Journal of Health and Social Behavior 24: 255–263.

    Google Scholar 

  • SmedbyB., SmedbyO.S., EricksonE.A., MattsonL.G. & LindgreenA. (1984). “Continuity of care: An application of visit-based measures”, Medical Care 22: 676–680.

    Google Scholar 

  • SmedbyO., BlundG.E., EricksonE.A. & SmedbyB. (1986). “Measures of continuity of care: A register-based correlation study”, Medical Care 24: 511–518.

    Google Scholar 

  • StollerP. (1982). “Patterns of physician utilization by the elderly: A multivariate analysis”, Medical Care 20: 1080–1089.

    Google Scholar 

  • TannerJ.L., CockerhamW.C. & SpaethJ.L. (1983). “Predicting physician utilization”, Medical Care 21: 360–369.

    Google Scholar 

  • ThomasJ.W. & PenchanskyR. (1984). “Relating satisfaction with access to utilization of services”, Medical Care 22: 553–568.

    Google Scholar 

  • WanT.T.H. (1982). “Use of health services by the elderly in low income communities”, Milbank Memorial Fund Quarterly Health and Society 60: 82–102.

    Google Scholar 

  • WanT.T.H. & OdellB.G. (1981). “Factors affecting the use of social and health serivices among the elderly”, Ageing and Society 1: 95–115.

    Google Scholar 

  • WolinskyF.D. (1978). “Assessing the effects of predisposing, enabling and ilness-morbidity characteristics on health service utilization”, Journal of Health and Social Behavior 19: 384–396.

    Google Scholar 

  • WolinskyF.D., CoeR.M., MillerD.K., PrendergastJ.M., CreelM.J. & ChavezM.N. (1983). “Health services utilization among the noninstitutionalized elderly”. Journal of Health and Social Behavior 24: 325–337.

    Google Scholar 

  • WrightR., BergW.E. & CreecyR.F. (1980). “Health care utilization among the elderly: A causal analysis”, Journal of Social Service Research 3: 253–265.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Groupe de Recherche Interdisciplinaire en Santé, Pavillon Marguerite d'Youville, Université de Montréal, 2375 Chemin de la Côte Ste-Catherine, C.P. 6128, Succ. A., H3C 3J7, Montréal, Québec, Canada

    François Béland

Authors
  1. François Béland
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Béland, F. Utilization of ambulatory care studies: testing the assumptions. Qual Quant 25, 137–150 (1991). https://doi.org/10.1007/BF00145702

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00145702

Keywords

Search

Navigation