Use Of Health Care By Urban American Indians In Michigan (medicine, Accessibility, Cultural Affiliation).

Abstract

American Indians tend to use fewer medical services than does the general population, despite a higher level of need, and little is known about the utilization behavior of urban Indians. The purposes of this study are: (1) to identify some of the factors that influence the use of Anglo medical care (AMC) and traditional Indian medical care (TIMC) among Michigan urban Indians and (2) to determine the relationship between their use of the two systems of health care. The data were obtained from a household survey of Indian families (N = 317) conducted in 1979-80 in urban areas of southeastern and mid-Michigan. Four factors were predicted to influence utilization behavior: need, accessibility of Anglo care, acceptability of Anglo care, and affiliation with Indian culture. Factors associated with AMC use were derived by stepwise regression for a continuous dependent variable, and those associated with TIMC use by stepwise logistic regression. Non-parametric tests of association were used to measure the relationship between using the two systems of care. Only need proved to be associated with the use of AMC, especially in terms of the family as a whole. Accessibility, acceptability and cultural affiliation were not associated with the use of AMC. If anything, urban Indians seemed to encounter greater inconvenience as their utilization increased. Affiliation with Indian culture was the only factor consistently related to the use of TIMC. Families with a greater number of cultural attributes were more likely to use at least one mode of TIMC. Furthermore, although need in general was not associated with TIMC use, family members with more bed-disability were more likely to use TIMC. A positive association between use of the two systems of care was predicted, but it was not supported by the data. The limited availability of TIMC in urban areas may account for limited use of TIMC for therapeutic purposes.