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Access to ambulatory care for American Indians and Alaska Natives; the relative importance of personal and community resources

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  • Cunningham, Peter J.
  • Cornelius, Llewellyn J.

Abstract

The debate on health care reform in the United States has been greatly influenced by various national studies showing a strong relationship between lack of public or private health care coverage and inadequate access to health services. There is also much concern about deficiencies in the availability and delivery of services to certain population groups--especially for those living in the most remote and sparsely populated areas of the country. However, national studies have generally not demonstrated that the use of health services is strongly associated with urban/rural residence or the supply of medical providers. In this study, we show that national studies can obscure the problems of certain population groups including American Indians and Alaska Natives. Using data from the 1987 National Medical Expenditure Survey, the findings show that the availability of medical providers as well as place of residence were strongly associated with the use of health care by American Indians and Alaska Natives. Although American Indians and Alaska Natives included in this study were eligible to receive health care free of charge from the Indian Health Service (IHS), financial factors were also significantly associated with use due to the use of services other than those provided or sponsored by IHS. Also, the results show that while geographic and supply factors have only modest effects on the average travel time to medical providers for the U.S. population as a whole, travel times are dramatically longer for American Indians and Alaska Natives living in rural areas and where there are few medical providers. In addition, there appear to be fewer hospitalizations in areas where there are IHS outpatient services. We conclude by discussing the need for health care reform to take into account the diversity of a large country such as the U.S., and the special needs of population groups that are usually not adequately represented in national studies.

Suggested Citation

  • Cunningham, Peter J. & Cornelius, Llewellyn J., 1995. "Access to ambulatory care for American Indians and Alaska Natives; the relative importance of personal and community resources," Social Science & Medicine, Elsevier, vol. 40(3), pages 393-407, February.
  • Handle: RePEc:eee:socmed:v:40:y:1995:i:3:p:393-407
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    Citations

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    Cited by:

    1. Yanhong Gong & Xiaoxv Yin & Yunxia Wang & Yongbin Li & Geng Qin & Liqun Liu & Wei Zhou & Fujian Song & Xiaoxin Dong & Shiyi Cao & Chen Yang & Huajie Yang & Jun Xie & Junan Liu & Zuxun Lu, 2014. "Social Determinants of Community Health Services Utilization among the Users in China: A 4-Year Cross-Sectional Study," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.
    2. Thorsen, Maggie L. & Harris, Sean & Palacios, Janelle F. & McGarvey, Ronald G. & Thorsen, Andreas, 2023. "American Indians travel great distances for obstetrical care: Examining rural and racial disparities," Social Science & Medicine, Elsevier, vol. 325(C).
    3. K. Bruce Newbold, 1997. "Aboriginal Physician Use in Canada: Location, Orientation and Identity," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 197-207, March.

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