It was hypothesized that the distribution of programs in the United States designed to improve effective, comprehensive use of primary health care (home health, family planning, rehabilitation, mental health, medical social work, and chronic disease screening programs) are more related to the environmental resources of a particular community than the needs of that population. Hospitals in poor communities were significantly less likely to provide any of these services than those in more wealthy areas. The discrepancies between the services provided in poor as opposed to more wealthy areas by health departments were less. Health departments were significantly more likely to provide chronic disease screening and family planning services in poor areas. In general, medical social work, rehabilitation, and mental health services tended to be more emphasized in more wealthy areas while chronic disease screening and family planning services seemed to get more emphasis in poor areas. The implications of these findings for understanding the political economic dynamics within the health sector and the formulation of change strategies are discussed.
© Lippincott-Raven Publishers.