FIGURE 6 Percentage of people in 1989 who were in poor or fair health (by their own report) and who did not contact a physician. The figure, which is based on data from the 1989 National Health Interview Survey, shows the percentages by health insurance status.

one considers ratios of low-income to high-income area admission rates for all referral-sensitive procedures combined, people from poor areas appear to be about two-thirds as likely to obtain the services. The most marked differences in rates of use of procedures were for breast reconstruction, coronary artery bypass grafts, and coronary angiography.

Ongoing medical management can effectively control the severity and progression of a number of chronic diseases, even if the diseases themselves cannot be prevented. An advanced stage of a chronic disease requiring hospitalization may indicate the existence of one or more access barriers to personal health care services. Thus, hospital admissions for certain



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