Patterns of medical use by the indigent aged under two systems of medical care.

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Abstract
In September 1962, the Department of Welfare enrolled about 13,000 recipients of public assistance in 7 of the medical groups affiliated with HIP [Health Insurance Plan] in an effort to bring Welfare clients into the main-stream of medical care. Twelve thousand of the new enrollees were receiving Old Age Assistance (OAA) and living in their own homes; the others were patients in nursing homes. Study of experience in the program indicates changes in pattern of physician utilization among the ambulatory HIP-OAA''s although overall physician and hospital utilization rates did not appear to be influenced by enrollment in HIP. The proportion of HIP-OAA''s who received no physician services went down somewhat whereas the corresponding proportion in the non-HIP group remained unchanged. There was a major change in where the HIP patient saw the physician; the shift being from high dependence on home visits to out-patient care in the medical group center. Patients who tended to be low utilizers were likely to get more service than they did otherwise; patients who in the pre-demonstration period used many physician services continued to obtain large volumes of care but averaged fewer doctor visits in HIP than under the traditional system. Nursing home patients showed no change in physician or hospital utilization rates. During the study year, the death rates among the indigent age in HIP and those not in HIP were about the same. In the next year and a half, mortality among the ambulatory HIP-OAA''s was lower man among the other OAA''s. Potential for additional research exists in view of the Medicaid program in New York that started in 1966. Under the new program medically indigent of all ages are enrolling tn HIP and coverage includes both out-of-hospital and in-hospital care.

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