Bong Chul Chu, PhD, MHA¹, Kathleen Gillespie, PhD², Richard S. Kurz, PhD², James Romeis, PhD², and Mark Johnston, PhD³. (1) Prevention Research Center, Pacific Institute for Research and Evaluation, 1995 University Ave, Berkeley, CA 94703, 510-368-1459, bchu@prev.org, (2) School of Public Health, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104, (3) Outcomes Research, Kessler Medical Rehabilitation Research and Education Corporation, 1199 Pleasant Valley Way, West Orange, NJ 07052

Objective. To examine the effects of market-level factors on (1) the use of physician services and on (2) the relationships between need factors and physician utilization for individuals with special health care needs.

Data Sources and Sample. The 1998 Community Tracking Study Household survey provided data on individuals. The 1998 InterStudy National HMO Census provided data on market-level factors in 61 Metropolitan Statistical Areas (MSAs). Individuals aged 18 years or older with special health care needs residing in the MSAs were selected for the study.

Methods. Multilevel models were used to explore the effects of market-level factors.

Principal Findings. Mean level of physician utilization and the effects of mental health index and a measure of individuals' perceived general health on physician utilization varied substantially across MSA. Full multilevel models indicated that high HMO competition, a market-level factor, was associated with a tighter relationship, characterized by a higher beta, between the utilization of physician services, and both perceived general health and mental health. Low percentage of African American populations in MSAs accounted for the weaker relationships among the variables.

Conclusions. More highly competitive health care markets are associated with the responsiveness of physician services more closely to individuals' mental health status and perceived general health. Highly African American dominated markets are associated with weaker responsiveness of physician services in relation to mental health and perceived general health status of individuals.

Key words. Special health care needs; individual-level factors; market-level factors; physician utilization; health status indicators; mental health

Learning Objectives: At the conclusion of this session, the participant will be able to

• articulate the extent to which the level of physician utilization vary across different geographic regions
• articulate how managed care plays important roles in accounting for variation in health services utilization
• recognize the procedure for disparities in health of individuals with special health care needs, in association with managed care

Keywords: Health Care Utilization, Health Care Managed Care

Related Web page: www.kmrrec.org/KM/outcomes/index.php3

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.