How Economic Demand Influences Access to Medical Care for Rural Hispanic Children

Margot W. Smith, Richard A. Kreutzer, Lynn Goldman, Amy Casey-Paal, Kenneth W. Kizer

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


OBJECTIVES. In a study of access to medical care, the authors analyzed the relationship between factors influencing demand, local unmet needs, and the availability of physicians in a rural California community. METHODS. The California Department of Health Services screened 1,697 (90%) of children aged 1 to 12 years in McFarland, CA. The relation of demand to unmet needs was examined using multiple logistic regression. Factors influencing demand for medical care were: ability to pay (income, health insurance) desire to purchase care (ethnicity, education, perceived need), and incidental costs (transportation, child care, etc). Questions from the Hispanic Health and Nutrition Survey were reconstrued to fit the demand model. Local need and demand for physicians was compared with state levels to assess whether sufficient physicians were available. RESULTS. Eighty-six percent of the children were of Mexican ancestry. Factors influencing demand were linked with specific unmet needs. Although unmet needs were high, demand was low; 46% of all families were below the poverty level. Although four primary care physicians were needed, only one could be supported in the private sector because of low demand. CONCLUSIONS. Advantages to the demand model are: (1) it shows why medical services are underused and lacking in low-income areas although need is high, (2) it permits an economic rationale for extra services for poor diverse populations, (3) it estimates the amount of resources lacking to assure adequate levels of care, (4) it shows why facilitated access is needed for certain groups.

Original languageEnglish (US)
Pages (from-to)1135-1148
Number of pages14
JournalMedical Care
Issue number11
StatePublished - Nov 1996
Externally publishedYes


  • Access to care
  • Demand
  • Health services research
  • Hispanic children
  • Physician availability

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)


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