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Elliott Fisher, MD, MPH; H. Gilbert Welch, MD, MPH; John E. Wennberg, MD, MPH
Dartmouth Medical School Hanover, NH

JAMA. 1992;268(10):1268.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—As stated in our article, we agree with Dr Caper about the importance of modifying the implementation of constraints on the local bed supply based on detailed knowledge of local conditions. We also recognize that different hospital utilization patterns are observed in areas of greater poverty. We question, however, the degree to which the overall hospitalization rates in poverty areas are determined by morbidity levels.

The study cited by Caper is most consistent, in fact, with the hypothesis that it is the lack of insurance and the lack of adequate access to primary care services, not morbidity, that are the major predictors of higher hospital-use rates among the poor.¹ First, Billings and Hasselblad¹ found similar rates of admission across income levels for conditions in which illness determines the need for hospitalization, such as acute myocardial infarction and hip fracture. Second, the relationship between admission rates and . . . [Full Text PDF of this Article]

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