THE RELATIONSHIPS AMONG DIMENSIONS OF HEALTH SERVICES IN TWO PROVIDER SYSTEMS: A CAUSAL MODEL APPROACH.

This paper develops and tests a model of the health services delivery system based on an examination of the interrelationships among patient and provider variables (treated as exogenous) and access, utilization, continuity, quality, and satisfaction with medical care services (treated as endogenous). The model is tested using data collected from 106 hypertension patients enrolled in the Seattle Prepaid Health Care Project during the period February 1, 1971, through June 30, 1973. Several findings of both sociological and public policy interest emerged. Perceived access to care was among the most important predictors of patient satisfaction: patients from larger families were less satisfied with their care and experienced poorer outcomes of care; patients receiving care from independent fee-for-service practitioners experienced better outcomes than patients receiving care from prepaid group practice providers, even though the latter met a higher percentage of indicated criteria for care; and there was no relationship between perceived access to care and annualized visits. Several important interaction effects involving the nature of the provider system were predicted and supported by the data. The findings are viewed as a first step in the development of a "middle-range" theory of health services delivery systems. [ABSTRACT FROM AUTHOR]