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Hospital and Ambulatory Service Use by the Urban Elderly Under Different Health Care Delivery Systems

For a sample of elderly persons living in an urban community, patterns of use of health-care services varied according to whether or not respondents identified one of three fee-for-service delivery systems as their primary source of care: a hospital, a private physician, or a medical group practice. Differences in utilization patterns persisted even when population health and socioeconomic characteristics were controlled, and are attributable either to differences in system structure or to the population's behavioral response to these systems of care. As expected, the health variables, as well as whether or not persons had a source of care, were the most important factors in explaining aggregate inpatient and ambulatory care visits. In addition, particular sources of care and socioeconomic variables were significant in explaining duration of time spent in hospital and types of ambulatory care visits. Policy implications of these and related findings are discussed.