title: Health risks, ability to pay, and the use of primary care: is the distribution of service effective and equitable?
abstract: BACKGROUND
  This study clarifies the confusion about what factors are consistent predictors of primary care service use, of which preventive services are a major component. A variety of health risk, predisposing, and enabling characteristics were assessed for their association with the use of primary care. Variable selection was guided by the use of the Andersen-Newman Behavioral Model of health service utilization.
  
  
  METHODS
  The responses of 1,512 residents of Oklahoma to the BRFS survey were used in this study. Both probit and logistic analyses were used to assess the use of nine preventive services and a summary index of service use.
  
  
  RESULTS
  The results indicate that those at greater risk of illness and least able to use finance services have the lowest rates of use among the nine preventive services individually and when combined as an index of overall primary care use.
  
  
  CONCLUSIONS
  Problems persist with the adequate distribution of primary care among the medically vulnerable. Furthermore, recent welfare and health reforms may present added obstacles to their access to quality primary care services. The paper concludes with a discussion of policy options that may improve the effectiveness of primary care and redress inequities in the use of these services.
authors.affiliation: Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Broyles
authors.forename: L
authors.initials: L
authors.lastname: Narine
authors.forename: E N
authors.initials: EN
authors.lastname: Brandt
authors.forename: D
authors.initials: D
authors.lastname: Biard-Holmes
mesh_terms: D015438:Health Behavior; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008489:Medical Indigency; D009825:Oklahoma; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors