Financial, organizational and professional factors affecting health care utilization.

This paper explores the effects of specific provider and system features on patients' use of health care, including financial, time and organizational barriers, practice patterns and physician characteristics. The data are from a survey of 3058 family members and their usual providers in Washington, D.C. Findings indicate that a low-income practice clientele and high charges were the most significant deterrents to use, followed by absence of Medicaid, distance, limited hours and patient-sharing by physicians. Charges and distance had a disproportionate impact on the poor. The combined impact of structural barriers in hospital outpatient departments reduced access by roughly 50% compared with private settings. Policy implications are discussed.