Specialty bias in obstetric care for high-risk socioeconomic groups in Maine.

From 1982 to 1984, 46,501 infants were born in Maine hospitals in 46,286 deliveries, of which 6,343 were born to women on state Medicaid (Title 19), and 6,307 were born to women with no health insurance. In comparison with others born in Maine during those years, more infants in these presumed low socioeconomic groups died, were transferred immediately to other hospitals, had low birthweights, or were readmitted to a hospital within 30 days of birth. Of all deliveries, 105 family physicians or general practitioners performed 22 percent, 82 obstetricians performed 69 percent, and 16 osteopathic physicians performed 5 percent; but of Medicaid deliveries, obstetricians delivered only 59 percent, while family physicians-general practitioners and osteopaths did commensurately more. The decreased proportion of Medicaid patients cared for by obstetricians was especially prominent in Maine's urban hospital service areas. Pediatricians, on the other hand, cared for the same proportion of Medicaid children as they did all children in all hospital service areas in the state. The distribution of low socioeconomic, higher obstetric risk patient groups among various medical specialties as demonstrated in these data should be considered by health planners, malpractice insurers, and health insurers including state Medicaid programs.

Patient requests in a family practice setting.

The objectives of this study were to determine empirically the range of requests of persons seeking medical care and the relationship between request patterns and sociodemographic characteristics of patients. One-hundred and twenty-nine adult patients of a family medicine clinic completed a 34-item request inventory composed of seven hypothetical request categories. Factor analysis showed that four factors could explain 60% of the overall variance in responses. Analysis of variance using these four request categories (Psychosocial, Medical Explanation, Supportive Communication, Test Results/Reassurance) as dependent variables indicated significant differences in the requests of patients from various socio-economic backgrounds. Individuals who were single, divorced, Medicaid users, or recipients of free health-care service requested more psychosocial assistance than others. These results serve to underscore the importance of eliciting and identifying patient requests, keeping accurate records of patient demographics, and utilizing this information when creating, negotiating, and implementing treatment plans for individual patients.