Latest Data on Ambulatory Medical Care in America

New Information Available on Managed Care

Contact: NCHS Press Office (301) 458-4800

E-mail: paoquery@cdc.gov

With the publication of the latest annual summary from the National Ambulatory Medical Care Survey and the Internet release of more detailed data, researchers and policymakers have new information on patterns of medical care in America. For the first time, the survey reports whether authorization was required for a doctor visit and whether it was a capitated visit. There’s extensive data on referral paths for patients and the role of the primary physician as well as specialists. Also new to this year’s report from the CDC’s National Center for Health Statistics are data on physicians’ practice characteristics--such as ownership, size and office type.

The 1997 annual report also analyzes the 787 million visits made to the doctor that year in terms of patient symptoms and diagnoses; age, gender and race of patients; screening and diagnostic tests; treatments and drugs provided; source of payment; and specialty of the physician.

Key findings of the report show that:

• The 787.4 million visits to physician offices in 1997 resulted in an overall rate of 3 visits per person per year.
• Women were more likely to visit the doctor than men, especially at younger ages. By age 75--when visit rates are the highest--men and women visit the doctor at about the same rate.
• Of all visits made to the doctor in 1997 approximately 50 percent listed private insurance as the primary expected source of payment and about 30 percent of the visits were made by HMO patients.
• About 15 percent of visits were the result of a referral by another physician or health plan. One in 10 visits required authorization and just over 11 percent were capitated.
• Half of all visits were to the patient’s primary care physician. One quarter of visits were to a general or family practice physician; internal medicine accounted for another 15 percent; pediatrics almost 12 percent; and obstetrics and gynecology, 9 percent.
• The overwhelming majority--over 75 percent--of physician visits were made to practices owned by the physician/group, however the proportion ranged from a high of almost 87 percent for surgical specialists to 70 percent for primary care physicians. Ten percent of the visits to primary care specialties were to physician practices that were owned by a hospital, a considerably higher proportion than that for specialists.

NCHS has also just released two new annual reports on visits to hospital emergency departments and outpatient departments. These data are from the 1997 National Hospital Ambulatory Medical Care Survey and complement the information collected in the survey of visits to physician offices.

During 1997, an estimated 94.9 million visits were made to hospital emergency departments, about 36 visits per 100 persons per year. Similar to the pattern for office visits, those 75 years of age and over had the highest visit rate. Women ages 15-24 and 25-44 were more likely than men in those age groups to visit the emergency department, with visits for pregnancy complication and delivery, abdominal pain and urinary tract infection contributing to the differences. Overall, the emergency department visit rate among the black population was over 80 percent higher than that for white persons, reversing the pattern observed for physician office visits.

A new survey item records the immediacy with which the patient should be seen. About one-fifth of the visits were reported to be emergent, or requiring attention in less than 15 minutes. Another 32 percent were urgent and required care within one hour. Fifteen percent were judged semiurgent (needing treatment within 1-2 hours), while only about 10 percent were considered nonurgent (to be treated within 2-24 hours). About one-third of emergency department visits were injury related. Most of those were unintentional injuries such as those caused by falls, poisoning, fires, or motor vehicles. Over 2 million visits were for intentional injuries including assaults, fights, brawls, or self-inflicted injuries. Most of the injuries occurred at home with street or highways the second most likely place for an injury to take place.

About 77 million visits were made to hospital outpatient departments in 1997, for an overall rate of 29 visits per 100 persons per year. Visits did not vary greatly by age; but black persons had a higher rate of visits than white persons. About 20 percent of visits to outpatient departments were made by patients belonging to a health maintenance organization.

The National Ambulatory Medical Care Survey is a national probability survey of visits to office-based physicians in the United States; the National Hospital Ambulatory Medical Care Survey samples visits to hospital emergency and outpatient departments. Both are part of the National Health Care Survey, NCHS.

"National Hospital Ambulatory Medical Care Survey: 1997 Emergency Department Summary," Advance Data No. 304, by Parivash Nourjah; "National Ambulatory Medical Care Survey: 1997 Summary," Advance Data No. 305, by David A. Woodwell; and "National Hospital Ambulatory Medical Care Survey: 1997 Outpatient Department Summary," Advance Data No. 307, by Linda McCaig can be viewed or downloaded free from the NHAMCS Home Page.

The data sets and documentation from these surveys are also available for analysis at this website.