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Dimensions of the Social Environment: Medical

Overview

Health care services are generally considered to be an important determinant of health status (Andrulis 1998; Frenk 1998), although the degree that medical care impacts health status over and above social and economic conditions has been the subject of considerable controversy (Pincus et al. 1998; McKeown 1979). The medical contextual dimension encompasses a range of health care services, including primary care, specialty care, emergency services, home health care, mental health services, long–term care, oral health care, and alternative care.

We also look at access to health care services, which is related to health status and known to vary among population groups (USDHHS 2000). Some factors include insurance coverage and the availability of indigent care, are well–known determinants of access (Baker and Shapiro and Schur 2000; Newacheck et al. 1998; Nelson et al. 1999). The racial/ethnic makeup of medical staff to the patient population and the cultural competence of providers and institutions may also be important in encouraging utilization of health care resources that are present in an area (Flores et al. 1998; Langer 1999). In addition to traditional measures of access, we also include rates of hospitalization for ambulatory care sensitive conditions. These are conditions considered to be manageable on an outpatient basis, given access to high–quality primary care, and therefore higher hospitalization rates can be used as an indicator of poorer access to appropriate care (Institute of Medicine 1993).

This table presents the components and indicators of the medical dimension. Eight medical components are identified:

Within each component, several indicators are identified, and for each indicator at least one data set is listed.

One or more of the following files are available in Portable Document Format (PDF). Learn more about PDFs.

Components and Indicators

Data Sources and Notes

1. Primary Care: Number of providers

Number of nonfederal MD/DOs in primary care, family practice, general practice, internal medicine, ob/gyn, and pediatric primary care practice

American Medical Association Physicians Professional Data, Medical Marketing Service
(http://www.mmslists.com/main.asp)
Custom data tables in Excel may be purchased.

Primary Care: Provider training/competence/certification

Nonfederal physicians in primary care who are foreign medical graduates and who are board certified; hospital–associated medical staff who are board certified

Area Resource File (http://www.arfsys.com)
Data available for purchase on CD–ROM, magnetic tape, and cartridge.

Primary Care: Medicaid/Medicare reimbursement levels

Medicaid reimbursement rates for various medical services, including preventive care visits, immunization, critical care, emergency care, and surgery

American Academy of Pediatrics: Medicaid Reimbursement Survey* (PDF 299K)

Age, sex, race, illness, and price–adjusted reimbursements for noncapitated Medicare per enrollee

Dartmouth Atlas of Health Care*
Downloadable Excel files.

2. Specialty Care: Number of providers

Total number of nonfederal MD/DOs in medical and surgical specialty office practice

American Medical Association Physicians Professional Data Medical Marketing Services
(http://www.mmslists.com/main.asp)
Custom data tables in Excel may be purchased.

Specialty Care: Provider training/competence/certification

Nonfederal physicians in specialty care who are foreign medical graduates, and who are board certified; hospital–associated medical staff who are board certified

Area Resource File
(http://www.arfsys.com)

3. Emergency Services

Number of nonfederal physicians in emergency medicine patient care; number of hospitals with emergency departments

Area Resource File
(http://www.arfsys.com)

4. Home Health Care Services

Number of hospitals with home health services

Area Resource File
(http://www.arfsys.com)

5. Mental Health Care

Total number of nonfederal physicians in psychiatric, office–based patient care; number of hospitals with psychiatric emergency, outpatient, emergency social work, and outpatient social work services

Area Resource File
(http://www.arfsys.com)

6. Long–Term Care

Number of nursing and board–and–care homes and beds; number of long–term hospitals and beds

Area Resource File
(http://www.arfsys.com)

7. Oral Health Care

Total number of active dentists in private practice

Area Resource File
(http://www.arfsys.com)

8. Access to/Utilization of Care: Insurance coverage

Percent of persons aged 0–64 years who are uninsured, have job–based insurance, have no usual care source, and who delayed or went without needed care

Disparities in Health Insurance and Access to Care for Residents Across U.S. Cities* (PDF 207K)
Brown, E.R., R. Wyn, and S. Teleki. 2000.

Access to/Utilization of Care: Race/ethnicity staff–to–population ratios

Race/ethnicity staff–to–population ratios for primary care family practice, general practice, pediatric practice, internal medicine, ob/gyn, and medical and surgical subspecialties

Can be calculated from American Medical Association Physicians Professional Data, Medical Marketing Service (http://www.mmslists.com) and census data.

Access to/Utilization of Care: Provision of care in total and indigent care

Number of short–term general hospital admissions and emergency hospital outpatient visits

Area Resource File
(http://www.arfsys.com)

Access to/Utilization of Care: Costs of care

Average cost of routine MD visit, hospital room

American Chamber of Commerce Researchers Association*
Quarterly and annual average data may be purchased as downloadable spreadsheet or hardcopy.

Consumer expenditures on health care

Bureau of Labor Statistics (BLS)
From this Web site page, select Consumer Expenditures; select Tables Created by BLS; select current MSA tables grouped by region in text format or PDF.

Access to/Utilization of Care: Rates of ambulatory care sensitive hospitalizations

Rates of ambulatory care sensitive hospitalizations per 1,000 Medicare enrollees

Dartmouth Atlas of Health Care*

*Links to non–Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.