Primary care, income inequality, and self-rated health in the United States: A mixed-level analysis

Using the 1996 Community Tracking Study household survey, the authors exami ned whether income inequality and primary care, measured at the state level , predict individual morbidity as measured by self-rated health status, whi le adjusting for potentially confounding individual variables. Their result s indicate that distributions of income and primary care within states are significantly associated with individuals' self-rated health; that there is a gradient effect of income inequality on self-rated health; and that indi viduals living in states with a higher ratio of primary care physician to p opulation are more likely to report good health than those living in states with a lower such ratio. From a policy perspective, improvement in individ uals' health is likely to require a multi-pronged approach that addresses i ndividual socioeconomic determinants of health, social and economic policie s that affect income distribution, and a strengthening of the primary care aspects of health services.