Monitoring Health Care in America

Quarterly Fact Sheet - June 1997

Spotlight on: Ambulatory Care in the U.S.

A new report from the National Center for Health Statistics offers a first-time look at ambulatory care visits to a variety of health care settings in the United States for 1995. Some of the findings in the report include:

An estimated 860.9 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in 1995, a rate of 3.3 visits per person. Visits to office-based physicians accounted for 81 percent of ambulatory care utilization, followed by emergency departments (11 percent) and outpatient departments (nearly 8 percent).

The visit rate for black persons was higher than for white persons in emergency and outpatient departments, but the visit rate for white persons was higher than for black persons in physician offices. Less than two-thirds of the ambulatory care visits by black persons were to physician offices. Overall visit rates for black persons were lower than for white persons in only two age categories: under 15 years and 75 years and over. The other age categories had similar ambulatory care visit rates for white and black persons. In general, visit rates increased with patient age regardless of patient sex or race.

Private insurance was the most frequently expected source of payment, accounting for over 44 percent of the visits. Medicare accounted for one-fifth of the visits and Medicaid accounted for 13 percent of the visits. Roughly 1 in 10 visits had an expected source of payment of self-pay. Medicaid as a payment source ranged from 11 percent of visits in physician offices to a high of 29 percent on hospital outpatient departments.

"General medical exam" was the most frequently listed reason for visit as stated in the patient's own words, occurring in 6 percent of the visits. "Cough" was the leading reason related to illness or injury, occurring in over 3 percent of visits.

There were an estimated 126.1 million injury-related visits in 1995, representing 14.7 percent of the total number of visits. Roughly 6 out of every 10 injury visits were made to physician offices, compared with 3 out of 10 to emergency departments and 1 out of 10 to outpatient departments. An estimated 48.2 ambulatory injury visits were made for every 100 persons during 1995. The rate for males was higher than for females (52.3 visits compared with 44.2 visits per 100 persons).

Visits for intentional injuries accounted for 3 percent of the injury visits, with a rate of 14 visits per 1,000 persons. For persons between the ages of 18 and 64 years, at least 28 percent of the injury visits were related to the patient's employment. Unintentional falls was the stated cause of injury for 18 percent of all injury-related visits, followed by motor vehicle traffic accidents (10.4 percent).

The three most frequent illness diagnoses in ambulatory care visits were acute upper respiratory infection, essential hypertension, and otitis media. Most of the visits for these conditions were made to physician offices.

Medication therapy was reported at 6 of every 10 ambulatory visits in 1995, and at 7 of every 10 emergency department visits. There were 1.2 billion drugs mentioned at ambulatory care visits, which includes drugs either prescribed or provided at the visit (an average of 1.4 drugs mentioned per visit). Drugs for pain relief, antimicrobials and cardiovascular-renal drugs were the leading therapeutic classes of the medications prescribed (each accounting for about 14 percent of the drug mentions).

For copies of the report, "Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1995," or for further information about "Monitoring Health Care in America" please contact NCHS, Office of Public Affairs (301)-458-4800 or via e-mail at paoquery@cdc.gov.

Data Sources:

Vital and Health Statistics, Series 13, No. 129, June 1997