EFFECT OF INCOME ON USE OF PREVENTIVE CARE - EVALUATION OF ALTERNATIVE EXPLANATIONS

Three alternative explanations for the effect of income on use of physician services for preventive care are evaluated. Path analysis is used to estimate the direct effect of income on use (the financial constraint explanation), the indirect effect of income through health beliefs (the culture of poverty explanation), and the indirect effect through the availability of a usual source of care (the system barrier explanation). Data for the analysis are from household interviews with 781 adult residents of Washtenaw Country, Michigan. A general model of utilization of preventive health services is proposed that incorporates all three explanations. Path coefficients are estimated, and the direct and indirect effects of income on use are compared. The data reveal a negligible direct effect of income on preventive use, a positive indirect effect through perceived susceptibility to illness (one operationalization of the culture of poverty explanation), and a positive indirect effect through usual source of care. These findings are consistent with other recent research on the effect of income on health services ultilization and contribute to a growing body of evidence which suggests that changes in the health care delivery system may be necessary if we are to achieve equity in the utilization of preventive care services.