Vital and 

HealthStatistics


Advance Data 

From Vital and 

Health Statistics: 

Numbers 31–40 

Series16:


Compilations of Advance Data From 

Vital and Health Statistics 

No, 4 

Data in this report from health and demographic surveys present statistics by 

age and other variables on ambulatory medical care; sociodemographic 

and health characteristics of persons by private health insurance coverage 

and type of plan; an overview of nursing home characteristics; contraceptive 

utilization; and contraceptive utilization among widowed, divorced, and 

separated women. Estimates are based on the civilian noninstitutionalized 

population of the United States. These reports were originally published in 

1978. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health service


Centers for Disease Control


National Center for Health Statistics


Hyaflsville, Maryland


September 1990


DHHS Publication No. (PHS) 90-1863

Copyright information 

All material appearing in this reporl is m the public domam and may be 

reproduced or copied without permlsslon; c!tatlon as to source, however, IS 

appreciated. 

Suggested citation 

National Center for Health Statlstlcs. Advance data from wtal and health 

statistics: nos 3140 National Center for Health Statlst!cs Vltai Health Stat 

16(4). 1990. 
National Center for Health Statistics 

Manning Feinleib, M.D., Dr. P.H., Director 

Robert A. Israel, Deputy Director 

Jacob J. Feldman, Ph. D., Associate Director for Analysis 

and Epidemiology 

Gail F. Fisher, Ph.D., Associate Direc[or for Planning and 

Extramural Pmgn2ms 

Peter L. Hurley, Associate Director for Wal and Health 

Statistics Systems 

Stephen E. Niebercling Associate Director for ikhnagement 

Charles J. Rothwell, Associate Director for Dah Processing 

and Sewices 

Monroe G. Sirken, Ph.D., Associate Director for Reward 

and Mi4~odology 

Davicl L. Larson, Assistant Direcloq Atlanta 
Contents


Office Visits to Ophthalmologists: National Ambulatory Medical Care Survey, United States, 1976 . . . . . . . . . . . No. 31 

Sociodemographic and Health Characteristics of Persons by Private Health Insurance Coverage and me of


Plan United States, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 32


Office Visits to Otihopedic Surgeons, National tibulato~Medicd Care Sumey Utited States, 1975-76 . . . . . No.33 

Office Visits to Otola~golo~sts: National kbulato~Medical Cme Sumey, Utited States: 1975-76 . . . . . . . . No.34 

An Overview of Nursing Home Characteristics Provisional Data from the 1977 National Nursing Home


Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 35


Contraceptive Utilization in the United States: 1973 and 1976. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 36


Office Visits to Dermatologists: National Ambulatory Medical Care Survey, United States, 1975-76 . . . . . . . . . . No. 37 

Office Visits to Psychiatrists: National Ambulatory Medical Care Survey United States, 1975-76 . . . . . . . . . . . . ‘No. 38 

Office Visits to Urologist, National knbulato~ Medical Care Survey United States, 1975-76 . . . . . . . . . . . . . . . No. 3$1 

Contraceptive Utilization Among Widowed, Divorced, and Separated Woman in the .United States, 1973


and 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 40

FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH( EDUCATION, AND WELFARE � Publlc Health Service [ Number 31 I July 14,1978 

Office Visits To Ophthalmologists: National Ambulatory 

Medical Care Survey, United States, 1976’ 

Using data from the National Ambulatory 

Medical Care Survey (NAMCS), this report 

describes an estimated 29.3 million visits made 

to the offices of ophthalmologists in 1976. The 

NAMCS is a sample survey designed to explore 

the provision and utilization of ambulatory care 

in the physician’s office-the setting where most 

Americans seek health care. The survey is conduct ed yearIy throughout the coterminous 

United States by the Division of Health 

Resources Utilization Statistics of the National 

Center for Health Statistics. The survey sample 

is selected from doctors of medicine and osteopath y who are primarily engaged in office-based, 

pat ient-care practice. In its current scope, 

NAMCS excludes physicians practicing in Alaska 

and Hawaii; physicians whose specialty is anesthesiology, pathology, or radioIogy; physicians 

in Federal service. 

Because the estimates presented in this 

report are based on a sample rather than the 

en t ire universe of office-based, patient-care 

physicians, they are subject to sampling variability. See “Technical Notes” at the end of this 

publication for an explanation and for guidelines 

in judging the relative precision of estimates 

presented in this report. The directions offered 

there also provide the basis for judging the statistical significance of difference between estimates 

that the reader may desire to compare. 

1This report was prepared by Hugo Koch and Trena 

Ezzati, Division of Health Resources Utilization Statistics. 

DATA HIGHLIGHTS 

The listing that follows shows the prominent 

position occupied by ophthalmologists in the 

provision of office-based ambulatory care. ,With 

their 29.3 million visits in 1976, they were 

exceeded only by the primary care and/or more 

generalized practitioners. Among the officebase d specialties characterized by a more 

focus e d, f unctiomd specizdization, ophthalmology Ied aIl others in visit volume (table 1). 

Compared with the entire universe of officebased physicians, ophthalmologists showed a 

greater-than-average tendency to practice in 

metropolitan areas and in multiple-member practice arrangements (table 2). 

Table 1. Number of visits to office-based specialists, by type of 

specialty: United States, January-December 1976 

Number of 

Specialty Visits in 

thousands 

General and family practice .......................... 

Internal meticine ........................ .......... ....... . 

Pediatrics ...................... .. ............................. . 

Obstetrics and gynecology ........................... . 

General surgery ................... ............ .............. 

Ophthalmology ............................................. 

Orthopedic surgery ............... ....................... . 

Psychiatry ................................... .................. 

Dermatology ...... ................................ ........... 

Otolaryngology .................. ..................... ...... 

Urology ...................................... .................. 

Cardiovascular disease ............................. ...... 

Neurology .......... ........................................... 

225,637 

68,249 

60,400 

48,994 

35,967 

29,302 

27,837 

15,811 

21 ,62? 

10,837 

9,896 

5,961 

1,752 
2 achameciata 

Table 2. Number and percent distribution of office visits to ophthalmologists and percant distribution of office visits to all specialists, by 

characteristics of the’ physician: United States, January-December 1976 

Visits to 

Visits to ophthalmologists all 

specialists 

Physician characteristic 

Number Percent Percent 

in 

distribution distribution 1 thousands 

All visits ............................................................ 

Location of practice 

Metropolitan area2 ........ ............................ .............. 

Nonmetropolitan area ............................................. 

Type of practice 

solo ....................................................... .................. 

Other ...........................................?.... ....................... 

lBasedon unestimated 588,3 00,170tisits made toalloffice-based 

2Location ~thin a standard metro politan statistical area (SMSA). 

A clear majority (59 percent) of visits to 

ophthalmologists were made by patients aged 45 

years and over. Females made 3 visits for every 2 

visits made by males, a ratio that differs little 

from the average tendency found in all officebased practice (table 3). 

Data about prior-visit status reveal that the 

average o f fice-based ophthalmologist dealt 

chiefly with patients that the physician had seen 

before. These returning patients accounted for 

an estimated 72 percent of all visits. The 28 percent of visits made by new patients, though a 

decided minority of all visits, still was twice as 

great as the comparable proportion found in 

overall office-based practice (table 3). New problem encounters (i.e., any problem presented by 

a new patient or a new problem presented by an 

old patient) accounted for about 38 percent of 

all visits. The remaining visits (i.e., old problems 

presented by old patients) represent a rough 

estimate of the average number of return visits 

made during the year for any given new problem. Thus, for the typical new problem presented in 1976, there was an average of 1.6 

return visits in the course of the year, a retumvisit rate that agrees closely with the average 

29,302 100.0 100.0 

23,684 80.8 73.6 

5,618 19.2 26.4 

16,528 56.4 60.2 

12,775 43.6 39.8 

physiciansin 1976. 

SMSA’sdo IIOtRfkt 1974 adjustments. 

return-visit rate for all office-based physicians 

(1.7). 

Table 4 presents data on the principal diagnoses most frequently rendered by the ophthalmologist. The “principal” diagnosis was the 

first-listed diagnosis on a survey form that permitted up to three diagnostic entries. Diagnostic 

terms and codes are those established by the 

Eighth Revision International Classification of 

Diseases, Adapted for Use in the United States, 

1968 (ICDA). It may be of interest to note that 

among the three-digit diagnostic categories the 

largest single proportion of visits (28, percent) 

were devoted to the diagnosis and/or correction 

of refractive errors. 

Table 5 points out the uniquely intense 

degree of diagnostic activity that characterizes 

ophthalmological office practice. Including the 

testing procedures classified under “other” services, every visit entailed an average of at least 

1.4 examinations or tests. The 18 percent of 

visits that, resulted in the ophthalmologist’s 

ordering or providing drugs for the patient were 

slightly less than one-half the frequency \vith 

which drug therapy was employed in overall 

office-based practice (in 43 percent of visits). 
dmcecMa3 

Table 3. Number and percent distribution of office visits to ophthalmologists and percent distribution of office visits to all specialists, by 

characteristics of the patient: United States, January-December 1976 

Patient characteristic 

All visits ............................................................ 

— 

Age

Under 15 years .. ...................................................... 

15-24 years ....................... ....................................... 

2544 yea rs.............................................................. 

45-64 years .............................................................. 

65 years and over .... ................... ............................. 

Sex 

— 

Female ................... ......................................... ........ 

Male ........ ................................ ................................ 

Prior-visit status 

New patient ................................................. ............ 

Old patient, new problem .............. ...... .................... 

Old patient, old problem ......................................... 

Visits to 

Visits to ophthalmologists all 

specialists 

Number 

Percent Percent in 

distribution distribution 1 thousands 

29,302 100.0 100.0 

3,225 11.0 18.7 

3,320 11.3 15.0 

5,510 18.8 25.7 

8.764 29.9 24.6 

8.483 29.0 16.0 

17,259 58.9 60.3 

?2,043 41.1 39.7 

8,099 27.6 14.2 

2,954 10.1 23.0 

18,250 62.3 62.8 

lBa~ed on an ~stima[ed 5ss,300,170 visits made to all office-based physicians in 1976. 

Table 4, Number and parcent of office visits to ophthalmologists, 

the physician: United 

Principal diagnosis most


commonly rendered by the


ophthalmologist and ICDA codes


Diseases of the nervous system 

and sense organs ......................................320-389 

Inflammatory diseases of the eye, ............36 O-369 

Conjunctivitis and ophthalmia ............... .......360 

Other diseases tmd conditions 

of the aye ................................. ........... 370-379 

Refractive errors . ..........................................370 

Myopia ......... ........................... ..... .......37o.o 

Hyperopia ... .. ..... ...... ............................370.1 

Presbyopia ..,., ......................................370.2 

Astigmatism .. ............ ......................... ..370.3 

Strabismus .......... ...... .................... ................373 

Cataract ........................................................374 

Glaucoma .....................................................375 

Other diseases of retina and 

optic nerve ..................................................377 

Other diseases of eye ................ ....................378 

... .................. ................378.7 

Accidents, poisonings, and violenca ...... .....800-899 

lThe ~erm ~~morbidjt~-re]a~ed>) aPPlies to a diagnosis that 

by principal morbidity-related diagnosesl most commonly rendered by 

States, January -December 1976 

Number of Percent 

visits in of 

thousands visits 

22,121 75.5 

3,396 11.6 

1,504 5.1 

18,361 62.7 

8,143 27.8 

2,604 8.9 

937 3.2 

1,307 4.5 

1,277 4.4 

964 3.3 

2,220 7.6 

2,490 8.5 

1,207 4.1 

3,064 10.5 

1,268 4.3 

1,079 3.7 

was associated with a pathological condition (ICDA codes 000-999). as 

opposed to a visit that was primarily associated with a routine examination or with a special condition such as surgica] aftercare or 

prenatal care. 
Table 5. Number and percent of office visits to ophthalmologists 

by selected diagnostic and therapeutic services ordered or 

provided: United States, January-December 1976 

= 

Diagnostic services: 

Examination {may include 

visual acuity test) ............................ 

Visual acuity test ....... ...................?.. 

Blood pressure check .......... ............. 

Therapeutic services: 

Drug prescribed. ............................... 

Office surgery .................................. 

Medical counsel ing., . ........................ 

Other services ... ................................ .. 

Number 

Percant of visits 

in of 

visits :housands 

17,445 59.5 

21,451 73.2 

781 2.7 

5,306 18.1 

1,284 4.4 

1,622 5.5 

11,378 3B.8 

The survey form was too general in design to 

eIicit many findings or procedures that were 

uniquely ophthalmological in character. This 

accounts for the relatively large proportion of 

visits (39 percent ) for which the services provided were classified as “other.” Along with 

sophisticated tests and treatments unique to 

ophthalmological practice, these other services 

presumably included the more routine activities 

such as prescribing low-vision aids, fitting contact lenses, and orthoptic training. 

Data on seriousness (table 6) express the 

ophthalmologist’s judgment as to the extent of 

impairment that might result if no care were 

available for the given problem. The data reveal 

that the average visit to the ophthalmologist 

does not center on the treatment of problems 

Table 6. Number and percent distribution of office visits to ophthalmologists and percent distribution of office visits to all specialists, by 

selected visit characteristics: United States, January-December 1976 

Visits to ophthalmologists 

Selected visit characteristic 

Number 

Percent in 

distribution thousands 

Visits to 

all 

specialists 

Percent 

distribution 

100.0 

19.5 

32.3 

48,2 

11,5


61.4 

21.5 

2.8 

2.1 

All visits ....................................... .... ................. 

Seriousness of problem 

Serious and very serious ......................................... . 

Slightly serious .......................................... .............. 

Not serious .................. .......... .......!...... ............... ..... 

Disposition (selected actions) 

No followup ............ .............................. ................. . 

Return at specified time .......................................... 

Return if needed ............. ................ ........ ................ 

Referred to other physician or agency ....... .............. 

Admit to hospital ....................... ...................... ....... 

Duration 

O minute (no face-to-face 

encounter with physician) ......................... ............ 

1-5 minutes ............................................................. 

6-10 minutes ........ ........ ........................................... 

11-15 minutes ................ ................. ........................ 

16-30 minutes .. ...................................... ................. 

31 minutes or more ........... ..................... ................. 

29,302 100.0 

# 

6,347 21.7 

7,171 24.5 

15,785 53.9 

4,211 14.4 

16,936 57.8 

7,147 24.4 

450 1.5 

679 2.0 

++309 �1.1 2.3 

2,733 9.3 14.1 

6,443 22.0 31.8 

8,897 30.4 26.4 

9,865 33.7 20.0 

1,056 3.6 5.4 

lBased on an ~stf~~t~d 588,300,170 visits made to all office-based physicians in 1976. 
---

dmcdata5


that are “serious to very serious” in prognosis, 

since only about one-fifth of all visits were 

assigned this evaluation. The majority of visits— 

slightly more than one-half—were given a “not 

serious” evaluation, probably reflecting in part 

the substantial proportion of ophthalmological 

office practice devoted to the diagnosis and 

correction of refractive errors. 

Some form of scheduled return visit was the 

disposition that most frequently ended a visit to 

the ophthalmologist’s office (table 6). The nonserious character of- most ophthalmological 

office practice is reflected in the low frequency 

of hospital admission ( 1 of every 50 visits). 

Slightly more than two-thirds (68 percent ) -

of visits to ophthalmologists involved a doctorpatient contact that exceeded 10 minutes in 

duration (table 6). In overall office-based practice, ab out 52 percent of these contacts 

exceeded 10 minutes. A typic~ face-to-face 

encounter with the ophthalmologist probably 

lasted 17-20 minutes, as compared with the 

roughly estimated 15 minutes found for the 

average encounter in all office-based practice. 

SYMBOLS 

Data not available-—---—---—-—---——------

Category not applicable--–--–-------—--– . . . 

Quantity zero––-——-------—-—-————————— -

Quantity more than Obut less than 0.05— 0.0 

Figure does not meet standards of 

* reliabilityy or precision-—~————————— 
.

6 achancedata 

TECHNICAL NOTES 

SOURCE OF DATA: Data presented in this 

report were obtained during 1976 through the 

A1atio n al Ambulatory hfedical Care Suwey 

(NAMCS). The target population of NAMCS 

encompasses office visits within the coterminous 

United States made to physicians who are principally engaged in office practice. 

SAMPLE DESIGN: The 1976 NA!MCS utilized a 

mu 1t i stage probability design that involved 

samples of primary sampling units (PSU’S), 

physician practices within PSU’S, and patient 

visits within practices. Within the 87‘ PSU’S composing the first stage of selection, a sample of 

approximately 3,000 ph>’sicians was selected 

from master files maintained by the American 

Medical Association and the American Osteopathic Association. Sampled physicians, 

randomly assigned to 1 of the 52 weeks in the 

survey year, were requested to complete Patient 

Records (brief encounter forms) for a systematic 

random sample of office visits taking place within their practice during the assigned reporting 

period. (A facsimile of the Patient Record used 

is shown in a previous issue of Advance Data 

From Vil(ri and Health Statistics, No. 30, July 

13, 1978. Additional data concerning phl’sician 

practice characteristics such as primary specialty 

and type of practice were obtained during an 

induction interview. 

A complete description of the sun’ev’s background and developlnent has been pubiished in 

Series 2, No. 61, of I’ital and Hralth Statistics, 

DHEW’ Pub. No. (HRA) 76-1335, Health Resources Administration, Washington, U.S. Go\”­

ernment Printing Office, Apr. 1974. 

SAMPLING ERRORS: Since the estimates for 

this report are based on a sample rather than the 

entire universe, they at-e subject to sampling variability. The standard error is primarily a measure 

of sampling variability. The relative standard 

error of an estimate is obtained by di~’iding the 

standard error of the estimate by the estimate 

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table 1. The standard 

errors appropriate for the estimated percent of 

office visits are shown in table IL 

ROUNDING: Aggregate estimates of office visits 

presented in the tables are rounded to the nearTable 1. Approximate relative standard’ errors of estimated numbers of office visits 

Relative 

standard error in 

Estimate in thousands percentages 

points 

500.......................................................... 30,1 

1.ooo....................................................... 21.4 

2;ooo ................. ...................................... 15.3 

5<ooo ................................. ...................... 10.0 

lo.ooo ......................................... ............ 7.5. 

30.000 .......................... ........................... 5.1 

loo.ooo ................................................... 4.0 

550.000 ... ................................................ 3.5 

Exarrzpfe of use of table: An aggregate of 80,000,000 has a 

relative standard error of 4.3 pircent or a standard error of 

3,440,000 (4.3 percent of 80,000,000). 

Table 11. Approximate standard errors of percents for estimated 

numbers of office visits 

I 

I Estimated percent 

Base of percent 

(number of visits , or 5. or 10or 20 or 30 or ~. in thousands) gg 95 go 80 70 

I Standard error in percentage points 

1,000 ..................... 2.1 4.6 6.3 8.5 9.7 10.6 

3,000 ..................... 1.2 2.7 3.7 4.9 5.6 6.1 

5,000 ........ ..... ........ 0.9 2.1 2.8 3.8 4.3 4.7 

10,000 ............ ....... 0.7 1.5 2.fJ 2.7 3.1 3.3 

50,000 ................... 0.3 0.7 0.9 1.2 1.4 1.5 

100,000 ................. 0.2 0.5 0.6 0.8 1.0 1,1 

500,000 ....... .......... 0.1 0.2 0.3 0.4 0.4 0.5 

Example of use of ruble:’ An estimate of 30 percent based on 

an aggregate of 75,000,000 has a standard error of 1.2 perccnr. 

The relative standard error of 30 percent is 4.0 percent (1.2 

percent+30 percent). 

est thousand. The rates and percents, ho~rever, 

were calculated on the basis of original, 

unrounded figures. Due to rounding of percents, 

the sum of percentages may not equal 100.0. 

DEFINITIONS: An ambulator)’ patiwi is an 

individual presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any health cm-e institution on the 

premises. 

An office is a place that the physician iderLtifies as a location for his ambulator~ practice. 

Responsibility o~er time for patient care and 
achtancedata 7 

professional services rendered there gen$rally 

resides with the individud physician rather than 

an institution. 

A Zisit is a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working under the physician’s supervision for the purpose of seeking care and rendering health services. 

A physician is a duly licensed doctor of medicine (M. D.) or doctor of osteopathy (D. O.) currently in practice who spends time in caring for 

amb ulato~ patients at an office location. 

Excluded from X:4MCS are physicians practicing 

in Alaska and Hawaii; physicians who specialize 

in an e sthesioIogy, patholo~, or radiology; 

physicians \vho arc federallj ernploycd; phy: 

.sicians who treat only institutionalized patients; 

physicians empIoyed full time by an institution: 

and physicians who spend no time seeing ambulatory patients. 
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public HealthService I Number 32 � August 22,1978 

Sociodemographic and Health Characteristicsof Persons


by Private Health Insurance Coverage and


Type of Plan: United States, 19751


During 1975 the Health Interview Survey 

(HIS) questionnaire included a supplement on 

health insurance coverage, with special emphasis 

on whether persons covered by private plans 

were. members of prepaid group practice plans 

(hereafter “prepaid group”). Members of prepaid group plans were defined as including both 

those who belonged to plans classified as health 

maintenance organizations (HMO) and those 

who belonged to other prepaid group practice 

plans. 

A facsimile of the questionnaire used in this 

survey may be found in Series 10, Number 

115, of Vital and Health Statistics.2 The estimates produced from these data refer to the civilian noninstitutionalized population of the 

United States. AU estimates presented in this report are shown by private insurance coverage 

status (covered, not covered, and unknown 

whether covered), and among those covered, by 

whether they are covered only by a prepaid 

group plan, a fee-for-service plan, or by a combination of the two. The descriptive terms refer 

to the method of reimbursement to the do ctor. 

Thus fee-for-service plans include the Blue-type 

plans and indemnity plans in which the doctor 

receives only a payment specific to the service 

performed. Data, presented here do not include 

Medicare coverage or use of or eligibility for 

1This ~ePort w= prepued by Jai Choi and peter ~les, 

Division of HealthInterviewStatistics. 

2National Center for Health Statistics: Current estimates from the Health Interview Survey, United States, 

1975. Vital and Health Statistics. Series 10-No. 115. 

DHEW Pub. No. (HRA) 77-I 543. Health Resources 

Administration. Washington. U.S. Government Printing 

Office, hiar. 1977. 

Medicaid benefits. Also excluded are the 

following types of plans: those limited to”dread 

diseases, to income maintenance, and to accidents; veterans’ benefits and medlc~ care of military dependents; and those covering dental care 

only. 

Health Insurance Coverage Status by 

Selected %ciodemographic Characteristics 

Figure 1 and table 1 show the total civiliafi 

n on ins t i tutionalized population by private . 

health insurance coverage status. As may be 

Figure 1. PERCENT OF PERSONS BY PRIVATE HEALTH lNSURANCE COVERAGE STATUS: UNITED STATES, 197S 

m r, , 90


t


22.7 

20 

10 

0 IFee-for-service Prepaid group Not COVWd Unknown if 

pkn~ plan mvemd 

PRIVATE HEALTH INSURANCE COVERAGE STATUS 

1Exclud,.th, L91O,UIOFCW3IUwith fee.fcmmke phs wkotlto klong m Pm@ PUP plus, 
-----------------------------------

----------------------------

--------------------------- -------------------------

-------------------------

2


Table 1. Number of persons by private health insurance coverage statua and selected characteristics: 

United States, 1975 [Dataam bad on ho.xhold interview of tbc dvilian nonirutitntionalizd population. lk xurvq design, gCMI-A qdjticaiau, and information on the rrlMdity of the ettinmms arc 

Selected characteristic


All persons-----------------------


Age


—


O-64 years------------------------------


Under 17 years------------------------
 17-44 years---------------------------
 45-64 years---------------------------
 65 yesrs and over----------------------­


~ 

Male---------------------------------­
-.


Female----------------------------------


Race


~ite -----------------------------------


Black-----------------------------------
 Other-----------------------------------


Place of residence


SMSA----------------------------------­
-

Central city------------.-+-----------
 Outside central city------------------
 Outside SMSA----------------------------
 Nonfarm-------------------------------
 Farm----------------------------------


Geographic region


Northeast-------------------------------
 North Central---------------------------
 South


West------------------------------------


Education of head of familyz


Elementary school (O-8
 years)---------------------------------


High school (9-11 years)----------------


High school graduate (12 years)---------


College (13-15 years)-------------------


College graduste (16 years or over)-----


Family incomez


Under $3,000


$3,000-$4>999---------------------------


$5,000-$9,999
 $10,000-$14,999


$15,000-$24,999


$25,000 and over------------------------


Awn in the Teciuiral NO&] - -


II


II Coveragestatus


Prepaid plan
 I


All persona All Prepafd Fee-for- types of supple- service coverage All Prepaid mented only] prepsid only by fee-fOr­
 aervice


II I I 

Number in thousands


209,06! 158,085 6,532 4,62: 1,91( 151,552


187,77: 144,795 6,124 4,351 1,774 138,671 

61,94: 

82,73t 

43 ,09~ 

&,;;: 

35:481 

2,010 

2,664 

1,451 

1,45; 

1,92$ 965 

55: 735 

486 

43,075 

61,561 

34,031 

21,28; 13,290 408 271 13i 12,882 

100,86: 77,231 3,234 2,311 92? 73,997 

108,19S 80,853 3,298 2,311 987 77,555 

181,871 

24,39( 

143,028 

13,125 

5,310 

1,047 

3,771 

693 

1,539 

354 

137>718 

12,078 

2,795 1,932 175 158 *17 1,756 

143,654 111,111 5,948 4,181 L,767 105,163


61,562 43,646 2,930 2,068 861 40,717


82,093 67,464 3,018 2,113 905 64,446


65,41C 46,974 585 441 144 46,389


58,70C 42,201 5:; 405 137 4;,:;;


6,71C 4,773 35 *6 >


49,086 38,790 2,148 900 1,247 36,642


55,892 46,148 763 641 122 45,385


66,854 46,650 359 284 46,291


37,233 26,497 3,263 2,796 4:2 23,234


41,977 24,000 647 ;;; 150 23,353


34,544 23,443 881 289 22,562


68,238 55,126 2,021 1,431 ;;; 53,105


28,612 23,827 1,241 889 22,585


32,807 30,015 1,675 1,178 497 28,340


14,676 5,351 171 1.44 *27 5,180 17,074 7,530 241 200 7,289 45,273 30,561 962 757 2:; 29,600

47,103 40,470 1,689 1,276 413 38,780

48,872 44,290 2,211 1,419 792 :;,;;; 20,996 19,395 978 594 384 � 

Not Unknown if covered covered 

47,433 3,547


39,792 3,190


15,647 1,2G8


17,155 1,358


6,989 623


7,641 357


21>925 1,709


25,508 1,838


36,058


10,557


817


30,015 2,529


16,710 1>205


13,305 1,324


17,&18 1,018


15,604 895


1,814 124


9,442 85L


9,030 714


18,880 1,324


10,081 655


17,156 821


10,589 512
 12,091 1,021


4,339 446


2,370 422


9,014 311


9,197 348
 14,014 698


5,960 674


:,;m; 567


> 219


1Excludes the 1,910,000 persons with fee-for-service plsns who also belong to prepaid plans.
 ‘Excludes unknown status.


noted, only 3.1 percent of the population (6.5 

million persons) were reported to beIong to 

prepaid group plans. About 72.5 percent of the 

population (151.6 million persons) were covered 

by fee-for-servicetype plans only. No private


health insurance coverage of the types included 

was reported for 22.7 percent of the population 

(47.4 million persons). No data on coverage 

status were obtained for 1.7 percent of the population. 
-----------------------

------------------------------------

-----------------------------------

-----------------------------------

-------------------------

------------------------------------

dmcedaa3 

Table 2. Percent of persons by private health insurance coverage status and selected characteristics: 

united States, 1975 

[Data arc based o.houscbold interviews of the civilim noninstitutionalimd DOIXIM.IL The suIv& design, gencml q.alikations, &ridinformation on the reliability of the estimates arc

II Caverage atatua 

II II Prepaid plan Ill 

All I 

Selected characteristic >eraana All Prepsid 

All persona-----------------------


Age
 —


O-64 years------------------------------
 Under 17 years------------------------
 17-44 years---------------------------
 45-64 years---------------------------
 65 years and over 

Male


Female---------------------------------­


we 

White


Black


Other-----------------------------------


Place of residence


SUSA------------------------------------
 Centrsl city--------------------------
 Outside central city-----------------­
 ou~o:tsmMsA ----------------------------
 .---.-


Farm----------------------------------


Geographic region


Northeast----------:--------------------
 North Central---------------------------
 South-----------------------------------
 West


Education of head of family2 

Elementary school (O-8


years)--------------------------------­
 ‘High school (9-11 years)----------------
 High school graduate (12 years)---------
 College (13-15 ,years)-------------------


College graduate (16 years or over)-----


Family incomez


under $3,000----------------------------
 $3,000-$4,999---------------------------
 $5,000-$9,999---------------------------


$10,000-$14,999-------------------------
 $15,000-$24,999-------------------------
 $25,000 and over------------------------


types of coverage All Prepaid 

stipplemented prepaid only by fee-fOr- service 

Pertent of persons


100.0 100.0 100.0 

89.8 91.6 93.8 94.1 92.9
 29.6 28.5 30.8 31.5 29.0
 39.6 40.6 40.8 41.7 38.5
 20.6 22.4 22.2 20.9 2;.;
 10.2’ 8.4 6.2 5.9


48.2 ;;.; 49.5 50.0 48.3
 51.8 . 50.5 50.0 51.7


87.0 90.5 81.3 S1.6 80.6
 11.7 8.3 16.0 15.0 18.5
 1.3 1.2 2.7 3.4 *0.9


68.7 70.3 91.1 90.5 92.5 29.4 27.6 44.9 44.7 45.1 39.3 42.7 46.2 45.7 47.4 31.3 29.7 S.9 28.1 26.7 8.3 R ;:1 

3.2 3.0 0.6 0.8 *0.3 

23.5 24.5 32.9 19.5 65.3
 26.7 29.2 11.7 13.9 6.4
 32.0 29.5
 17.8 16.8 5;:: 6;:; 2:::


20.“1 15.2 10.8 7.9
 16..5 14.8 1?:; 12.8 15.1
 32.6 34.9 30.9 “31.0 30.9
 13.7 15.1 19.0 19.2 1s.4
 15.7 19.0 25.6 25.5 26.0


7.0 3.4 3.1 *1.4 ::; 2::: 1$:: 14.7 1::: 18:; 22.5 25.6 25.9 27.6 21.6 23.4 2s.0 33.s 30.7 41.5 10.0 12.3 15.0 12.9 20.1 

Fee-fOr- Not unk#wn


aemice ccwered only1 covered 

100.0 100.0 100.0 

91.5 83.9
 2S.4 33.0
 ;;.; 36.2


14.7
 8:5 16.1


46.2 48.2
 53.8 51.8


90.9 76.0 78.6
 S.o 22.3 20.1
 1.2 1.7 1.3


69.4 63.3 71.3 26.9 35.2 34.0 42.5 28.1 37.3 30.6 36.7 28.7 27.5 32.9 25.2 3.1 3.8 3.5 

24.2 19.9 24.1
 29.9 19.0 20.1
 30.5 39.8 37.3
 15.3 21.3 18.5


15.4 36.2 23.1
 14.9 22.3 14.4
 35.0 25.5 28.8
 14.9 12.6
 18.7 M li.9


3.4 19.0 8.8 19.4 9.8 1::: 29.5 19.7 

25.6 12.6 19.0 :;.; 8.5 1:.: 2.9


lExcludea the 1,910,000 persons with fee-fOr-service plans who also belong to prepaid plans.
 2Excludes unknown status.


Table 2 shows selected characteristics of per- only. This report will emphasize the characscms by health insurance coverage status. Series tenstics of those covered by the two major al­

~0, Numbers 66 and 117, present this type of temative types of private health insurance. 

data in terms of health insurance coverage status Focusing on those in prepaid group plans 
------------------

---------

-----------

-------------- ----------

------------------

------------

-------

4 

Table 3. Number and percent distribution of persons by pri­
 vate health insurance coverage and selected characteris­


tics: United States, 1975


[Datarebased cm houwhold km w of ttx civilim nonimstiuniondi.ud populati.m, Tn. suwq design, gm.mal q.: cations, and information on tic reliability of the 

estimates a. shown in th. T.< ical Not.sl 

Coverage status 

Selected Prepaid plan Fee-for-semicel
 characteristic


Number Number
 in Percent in Percent


thou- distri- thou- iistrisands but ion >ution 

All,peraon.+----- 6,532 100.0 151,552 100.0 

~


~:::------------------ 5,310 81.3 137>718 90.9 1,047 16.0 12,078 8.0 

Place of residence 

SMSA: Central city 2,930 &4.9 40,717 26.9 Outside central city- 3,018 46.2 64,446 42.5 Outside SMSA 585 9.0 46,390 30.6 

Geographic region


Northeast 2,148 32.9 36,642 24.2
 North Central 763 11.7 45,385 29.9
 South 359 46,291 30.5
 Vest------------------- 3,263 5::: 23,234 15.3


Education of head of


family3


Less than high school-- 1,528 23.4 45,915 30.3
 High school 2,021 30.9 53,105 35.0
 More than high school-- 2,916 44.6 50,925 33.6


Family income3


Under $10,000---------- 1,374 21.0 42,069 27.8
 $10,000-$14,999-------- ;,::; 25.9 38,780 25.6
 $15,000 and over , f+8. g
 60,497 39.9
 J


lExcludesthe 1,910,000 persona with fee-for-service
 plans who also belong to prepaid Plans.


‘Sxcludes persons of other races. 

3~cludes unknown status . 

(including those whose prepaid plans are supplemented with fee-for-service type plans) and 

those in fee-for-service type plans only, it may 

be noted that varying levels of differences and 

similarities are associated with each of the sociodemographic variables (table 3). Thus the 

patterns of membership are similar by age and 

sex (table 2). However, there are wide variations 

in terms of race, place of residence, geographic 

region, education of head of family, and 

family income. Data show that the prepaid 

group membership is proportionately higher 

among blacks, within central cities, in the Northeast and especially in the West Region of the 

count ry, among families where the heads have 

higher levels of education, and among families 

with higher incomes. 

Health-Related Characteristics by 

Health Insurance Coverage Status 

TabIe 4 shows the numbers and rates for 

several selected health-related characteristics by 

health insurance coverage status. The rates 

shown are czude rates which have not’ been 

adjusted to take into account any of the sociodemographic differences among the various 

coverage-status groups described in the previous 

section. Since any differences or similarities in’ 

rat es among the coverage-status groups may 

merely be a reflection of sociodemographic 

differences among the group’s members, it 

would not be legitimate, based on these data 

alone, to attribute the differences or similarities 

in the rates solely to the type of insurance 

coverage. 

Given this limitation, the rates may be 

compared in a purely descriptive manner, 

without any imp lied inferences regarding 

causation. As may be noted, the percent of persons with limitation of activity due to chronic 

conditions is similar in prepaid group and feefor-service plans (12.2 percent and 12.0 percent, respectively); the rates for restrictedactivity and bed-disability days, doctor visits, 

and hospital discharges associated with surgical 

treatment are higher for those in prepaid group 

plans. Among persons in prepaid group plans, 

the rates are lower for short-stay hospital discharges per 100 persons and days per short-stay 

hospital discharge. 

Ambulatory Care and Hospitalizations by 

Type of Health Insurance Coverage 

A great deal of interest has centered on 

whether participation in prepaid group plans 

would tend to lead to a greater use of ambulatory care services and to a reduced use of hospit al services. This reduced use might be 

reflected in a lower rate of hospitalization 

and/or shorter periods of stay in the hospital. 

The crude rates for those covered by the two 

types of plans suggest this pattern of proportionately more doctor visits and Iess hospitalizations for those covered by prepaid group 

plans. However, these differences may merely 

reflect the differing sociodemographic composition of the population covered by these two 

types of plans. Comparing the specific rates for 

the various sociodemographic categories serves 
---

-----------------------

achmdda5 

Table 4. Mmber and rate of persons by private health insurance coverage status and selected health characteristics: 

United States. 1975. 

[Data arc based on hosxhold intavicws of kc civilim nonimtitutionskd pop&ion. l%. sum& design, gc~ qualifications, and information on the reliability of the estimates arc 

shciitiiithe Technical Notes]


Coverage status


Prepaid plan Ill IIAll Selected health characteristic persons 

All types of coverage All Prepaid 

Prepaid

supplemented 

:~ee:-

only] 

Not 

covered 

urlk&Ow. 

covered prepaid only fe~~forservice 

II t I I 

Number in thousands


All persons----------------- ‘209,065 - 4,622 1,910 151,552 47,433 3,547 

Persons with Imitation of
 activity------------------------- 29,900 18,97S 795 579 215 18,183 10,464 458 

Restricted-actLvity days---------- 3,733,892 3,444,928 1:$,:f; 90,098 ;;, ;); 2,;~,7g 1,231,078 57,886 

Bed-disability &ys--------------- 1,371,418 8S5,323 , 27,855 , , 464,835 21,260 

Short-stay hospital days for dischsrges2---------------------- 235,607 1:: ,:;: 4,852 3,570 1,282 1;: ,;;: 71,815 2,9S8 

Short-stay hospital discharges 29,474 > 733 547 186 , 7,641 395 

Short-stay hospital discharges 

with surgical operation2--------- 16,071 12,176 492 354 138 11,684 3,706 189 Doctor visitsz-------------------- l,056j094 793,985 3S,248 26,531 11,717 755,737 245,673 16,436 

Rate


Percent of persons with Umitat ion of activity---------------------- 14.3 12.0 12.2 12.5 11.3 12.0 22.1 12.9 Restricted-activity days per person per year------------------ 17.9 15.5 19.0 19.5 17.8 15.3 26.0 16.3 Bed-disability days per person per year------------------------- 6.6 5.6 -.3 6.0 6.9 5.6 9.8 6.0 Short-stay hospital days per dischargez S.o 7.5 6.6 6.5 6.9 7.5 9.4 7.6 Short-stay hospital discharges per 100 persons2--------------------- 14.1 13.6 11.2. 11.8 9.7 13.7 16.1 11.1 Percent of discharges surgically treatedz------------------------- 54.5 56.8 67.1 64.7 74.2 56.4 48.5 47.s Doctor visits per person per year2---------------------------- 5.1 5.0 5.9 5.7 6.1 5.0 5.2 4.6 

lExcludes the 1,910,000 persons with fee-for-service plans who also belong to prepaid plans.


‘Unknown if subscribers of a plan used the facility of that plah.


to minimize the confounding influence of the Among families at the intermediate level of 

differences in the composition of the two popu- incom; and education, the average length of stay 

lations. per discharge for those in prepaid ,group plans is . . Table 5 shows the specific rates for doctor as great as or greater than ‘th;t for those in feevisits, and table 6 shows the specific rates for for-service plans. 

length of stay per hospital discharge. For doctor A report containing a more extensive and 

visits, the specific rates almost invariably show a detailed presentation of these data is in preparapattern of greater use by those in prepaid group tion. Copies of tabulations to be used in the 

plans.’ Regarding the average length of stay per forthcoming report are available upon request. 

discharge from a short-stay hospital, the specific To receive these copies, contact the Division of 

rates tend to be lower for those in prepaid group HeaJth Interview Statistics,’ National Center for 

plans. However, this relationship does not hold Health Statistics. 

for all of the subgroupings shown in table 6, 
----------------------------------

---

------------------------------------

----------------------------

---------------------------

---------------------------

-------------------------

-------------------------

---

6


Table 5. Number of doctor visital per person per year by private h-lth insurance coverage atatua and selected
 characteristics: United States, 1975


[Data
arcbared on household ~tefiew of *c * noninstitution.dized POPUbtiOn. mC sumY desian, general wdkkations, and krfomation on the mliahility of the estimates are 

sho& in the Technical Notes] 

Coverage atatua 

Prepaid planl


Selected characteristic ?eraona All typea of coverage All Prepaid 

Prepaid 

aupplemented 

Fee-foraervice only2 

Not covered 

Unknown if cnvered prepaid only by fee-fOr- service 

All


Number of dnctor visits per person


All persons----------------------- 5.1 50C 5.9 5.7 6.1 5.0 5.2 4.6


92 

Under 17 years-------------------------- 4.2 4.2 ;.; :.; 5.4 4.2 4.3 17-64 years----------------------------- 5.2 5.1 5.1 5.4 ;:; 65 years and over----------------------- 6.6 6+5 9;1 6:9 1::: 6.9 6.1 5.7 

— 

Sex

Name------------------------------------ 4.3 4.? :.: 4.8 5.6 4.3 4.2 4.0 Female 5.7 5.7 6.6 6.7 5.6 6.0 5.2 

Race 

White----------------------------------- 5.2 All other------------------------------- ::; ::; ;:! ::; ::? ::: 5.1 ::; 

Place of residence 

All SMSA’a------------------------------ 5.3 5.2 5.9 5.8 6.2 5.2 5.6 5.0 

Outside SMSA: Nonfarm------------------------------- 4.6 5.0 5.0 +5.1 4.6 4.6 4.1 

Farm------------------------------- 3.8 .::[ *3.1 *3.7 *- 3.9 3.7 *1.1 

Geographic region


Northeast------------------------------- North Central--------------------------- 5.3 ::; 5.4 

5.2 4.1 

5.1 

6.2 

*5.8 ;:: ::: 

4.9 

South----------------------------------- ::2 4.7 *9.7 4.7 4.4 ;:: West 5.9 5.5 ::; ::$ 5.9 5.9 6.1 3.5 

Education of head of family 

Elementary school (O-8 

yeara)--------------------------------- 4.9 4.7 8.3 4.7 4.3 High school (9-11 yeara)---------------- High school graduate (12 yeara)--------- 4.9 

4.9 4.7 

4.5 ::; 

5.0 ;:; 8.4 

4.4 4.7 

4.9 ::; 

5.1 

5.2 

College (13-15 yeara)------------------- 6.1 6:2 5.9 5.4 2:; College graduate (16 yeara and over)---- ::: ;:: 6.0 6.0 6.0 5.5 ::: 4.5 

Family‘income


Under $3,000 6.4 6.7 ;:: 11.1 ;;*., 6.6 6.3 4.2
 $3,000-$4,999 5.6 5.5


$5,000 -$9,999 5.2 6.1 ::: 7.9 lz- ::; i::


$10,000-$14,999 ::: 6.0 4.7 4.7 5.5
 $15,000-$24,999 ::: 4.5 ::; 4.7 ::: 4.9 4.9 5.0


$25,000 and over------------------------ 4.9 5.( 6.0 5.6 6.5 5.0 -L3.6
 *3.1


1 

May include utilization not covered by prepaid plan.
 ‘Excludes the 1,910,000 persons with fee-for-service plaus who also belong to prepaid plana.


SYMBOLS 

Datanotavailable-——--—————————


Categorynotapplicable—----—--—--——,


Quantityzero----—--------—-——————————


Quantitymore thanO but lessthan0.05-—


Figuredoesnotmeet standardsof


reliability orprecision
(morethan


30 percentrelative standarderror)
 ——-­


I 

...


-


0.0


*

----

------------------------------------

-------------------- ---------------

------------------

------------------------------- ----

------------------------------------

-------------------------

dmcedaa7 

Table 6. Number of short-stay hospital days1 per discharge by private health insurance coverage status and selected
 characteristics: United Statea. 1975


[Data ax based on ho.schold intmviews of the civilian nonimtitutionslized population. The survey design, g&nl quslificatiom, and infonnaticm on the reliability of the estimates arc 

5hOWTI in the Technical Notes]


Coverage status 

Prepaid planl


All
 Selected characteristic persons All Prepaid Fee-for- Not W-k&n
 tvDes of II I supule- service -— _.d
 c&erage II All IIPrepaid I m&ted I onlyz Icover’ covered
 prepaid only I by
 fee-fOr­


aervice I€ Number of hospital daya per discharge


All persons----------------------- 8.o 7.5 6-.9 7.5 9.4 7.6


— 

Age

Under 17 years-------------------------- 5.5 4.8 *5.O *4.4 *8.4 4.8 7.5 *3.2
 17-64 years----------------------------- 7.2 6.1 6.0 *6.2 7..2 8.4 6.7
 65 years and over----------------------- 1;:: 11.4 *11.7 *12.2 *lo .9 11.4 13.1 *15.8


—
sax


Male 8.9 8.0 6.’2 *7.5 8.1 11.4 8.2
 Female---------------------------------- 7.4 7.2 6.8 ::: 6.8 7.2 8.0 7.2


~


White----------------------------------- 7.9 7.0 6.8 7,5 7.4 9.4 7.9
 ;ph;;----------------------------------- ;:; *5.5 *5.9 *4.4 9.2 9.6 *6.7
 R *4.2 *3.5 *3.5 *- *4.4 *7.4 *-


Place of residence


Sea------------------------------------ *6.9 9.6 7.7 Central city-------------------------- ::; ;:: R ;:: *7.4 ;:; 

Outside central city 7.7 7.2 5.8 5.6 *6.3 7.3 %! ;:; Outaide SMSA---------------------------- 7.6 7.0 *7.3 *7.6 *7.O 9.0 *7.O 

Nonfarm------------------------------- Farm---------------------------------- ::; 7.0 

6.7 

*7.3 *. *7.6 *- *7.O 

*- ;:8 

6.7 9.1 

8.0 

*7.2 

*2.3 

Geographic region


Northeast------------------------------- 9.1 8.0 *9.9 *6.3 9.1 11.4 *9.4
 No& Central--------------------------- %; 7.7 *7.O *6.8 *8.2 7.7 10.2 *5.3
 7.0 *8.8 *8.2 *11.8 7.0 8,7 7.8
 West 1:2 6.0 5.5 5.2 *7.1 6.1 7.7 *7.2


Education of head of f=ily


Elementary school (O-8
 years)--------------------------------- 9.1 *5.7 *5.6 *6.1 10.8 *8.3 High school (9-11 years)---------------- ::; *7.2 *7.9 *3.8 ?:; 8.7 *6.5 High school graduate (12 years)--------- 7.1 u 7.8 7.3 *9.1 6.8 8.2 *7.1 College (13-15 years)------------------- 7.0 *7.3 *6.9 *8.7 7.0 8.6 *1O.9 

College graduate (16 years and aver)---- ::; 6.9 *5.1 *5.1 *5.1 6.9 7.5 *4.7 

Family income 

Under $3,000---------------------------- 10.3 11.5 *6.6 *6.6 *8.O 11.8 *13.9 $3,000-$4,999--------------------------- 10.3 10.2 *8.8 *8.7 *12.3 10.3 1::: *lO.O $5,000-$9,999--------------------------- 8.0 8.6 *9.4 *5. O 7.8 *8.O $10,000-$14,999 M *4.3 *8.2 1::$ *6.7 $15,000-$24,999------------------------- ::; ;.: ::2 *6.6 *5.9 ::; 3.0 *5.9 $25,000 and over------------------------ 7.4 . *5.9 *5.1 *6.9 7.3 9.3 *3.1 -


lMay include utilizationnot covered by prepaid plans.
 %xcludea the 1,910,000 persons with fee-for-se~ice plans who alao belong to prepaid plsna.


TECHNICAL NOTES 

The data presented in this report were sample of the civilian noninstitutionalized popuobtained from househoId interviews in the lation of the United States. During that year 

Health Interview Survey. These interviews were approximately 116,000 persons living in about 

conducted throughout 1975 in a probability 40,000 households were included in the sample. 
8 

The health maintenance organization questions Table II. Standard errors, expressed in percentage points, of 

were asked of each household member. estimated percentages 

Because the estimates shown are based on a 

sample of the population rather than on the Estimated percentages ‘ 

entire population, they are subject to sampling 8ase of percentage 

error. Standard errors appropriate for the esti- in thousands 2 5 10 20 

50 

mates of the number of persons are shown in tl- :; :; % % 

table I; standard errors appropriate for percentages are shown in table II. 70 ... .. .. .... .. .. ..... . .. .... . 

100.......................... 3.0 

2.5 

4.7 

3.9 

6.5 

5.4 

8.6 

7.2 

10.8 

9.0 

Table 1. Standard errors of estimates of aggregates 300 .. .. ... .... ... .. ... .. .. .. . 1.5 2.3 3.1 4.2 5.2 

500 ... .... . ..... .. . ... ... .. .. 1.1 1.8 2.4 3.2 4.0 

Standard 700 .. ... ... ..... ... . .... .. . .. 1.0 1.5 2.0 2.7 3.4 

Size of estimate error in 1,000 ... ... .. ... .. .. ... ... .. 0.8 1.2 1.7 2.3 2.9 

in thousands thousands 5,000 ..... .. .. .... . .. .. .. . .. 0.4 0.6 0.8 1.0 1.3 

10,000 ... .. .. .. .... . .... .. . 0.3 0.4 0.5 0.7 0.9 

20,000 ..... . .. .... . .. .... .. 0.2 0.3 0.4 0.5 0.6 

11 30,000 .. .... .. .. .... .. .. ... 0.1 0.2 0,3 0,4 0,5 

100......................................................................,. 18 

31 

40 

70.......................................................................... 

48 

15 

For a more detailed discussion 

T

of the limi57 tations and qualifications of data collected in 

125 the Health Interview Survey and for the size of 174 

237 sampling errors of the estimates on disability 

278 days, physician visits, and other rates, see Series 

10, No. 100, of Vital and Health Statistics. 
1

2

3

4

5

6

7

8

9

10

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health Service [ Number 33 ~ JUIY 18,1978 

Office Visits to Orthopedic Surgeons, National Ambulatory 

Medical Care Survey: United States, 1975-19761 

Using data from the National Ambulatory 

MedicaI Care Survey (NAMCS), this report 

describes an estimated 47,152,000 visits made to 

the offices of orthopedic surgeons over the 

2-year span from January 1975 through December 1976. NAMCS is a sampIe survey designed to 

explore the provision and utilization of ambulatory care in the physician’s office, the setting 

where most Americans “seek health care. The 

survey is conducted yearly throughout the 

coterminous United States by the Division of 

Health Resources Utilization Statistics of the 

Nation+ Center for Health Statistics. The survey 

sample is selected from doctors of medicine and 

osteopathy who are principally engaged in 

off ice-based, patient-care practice. Excluded 

from the sample are an indeterminate number of 

physicians who render some office-based ambulatory care but whose patient-care activities are 

secondary to another primary role such as 

teaching, research, or administration. Also excluded from the NAMCS scope are physicians 

who are hospital based; those whose specialty is 

anesthesiology, pathology, or radiology; and 

physicians in Federal Service. 

Because the estimates presented in this 

report are based on a sample rather than on the 

en t ire universe of office-based, patient-care 

physicians, they are subject to sampling variability. See the Technical Notes for an expkmation and for guidelines in judging the relative 

precision of estimates presented in this report. 

1This report was prepared by Hugo Koch, Division of 

IIeaJth Resources Utilization Statistics. 

The directions offered there also provide the 

basis for judging the statistical significance of 

differences between estimates. 

DATA HIGHLIGHTS 

With an estimated 47,152,000 office vkits 

during the 2-year span 1975-76, orthopedic 

surgeons occupied a position of middle prominence in the provision of office-based ambulatory care. This is evident from the listing ‘in 

table 1. 

Understandably heading the list are the five 

primary care and/or more generalized practi: 

tioners. Among the other office-based “providers 

of ambulatory care-those generally characterized by a more focused clinical speciaIization— 

orthopedic surgeons were second only to 

ophthalmologists in volume of visits. 

Table 1. Number of office visits to the 13 most visited specialists, 

by type of specialty and rank order: United States, 1975-76 

Number of visits Rank Type of specialty in thousands 

General and family practice ....... 460,297 

Internal medicine ............ ...... ..... 130,367 

Pediatrics ... .. .. .. .. .. . .... . .. ... . . ..... .. ... 107,085 

Obstetricsand gynecology .... .. . .. 97,070 

General surgery ... ..... . . ... .. . .... .. .. .. 77,259 

Ophthalmology ... .. ... . . ... .. .... ... .. .. 53,969 

Orthopedicsurgery..................... 47,152 

Dermatology ... . .. .. .... .. .... . . .... .. . ... 35,721 

Psychiatry ... .. .. .. .. .. .. . .. .. .. . .. .... .... .. 30,616 

Otolaryngology . . . .. .... .. .. .. .. .. .. .. ... 27,192 

71 Urology .. . ... . .. ... ... . .. ... . ... .. . ... ... .. .. 20,728 

12 Cardiovascular diseasa ... .. ... .. ... . .. 13,517 

13 Neurology ... ... . . .. . ... . ... ... . .. .... .. .... 3,784 
2


Compared with the entire universe of officebased physicians, orthopedic surgeons reversed 

the overall preference for solo over multiplemember practice (table 2); more than one-half 

of visits to orthopedic surgeons (55 percent) 

were made to physicians in multiple-member 

practice arrangements. 

Table 2. Number and percent distribution of office visits to 

orthopedic surgeons, and percent distribution of office visits 

to all specialists, by characteristics of physician: United 

States, 1975-76 , 

Visits to Visits to 

Physician orthopedic surgeons all specialists

characteristic Number in Percent Percent 

thousands ~istribution distribut ionl 

All visits ........... 47,152 100.0 100.0 

Location of practice 

Metropolitan area2 ... . . 36,585 77.6 73.3 

Non metropolitan 

area . .. .. .. ... .. .. .. .. .. ..... . 10,567 22.4 26.7 

Type of practice 

S910........................... 21,401 45.4 60.0 

Other..., . . .... .. .. .. ... . .... . 25,751 54.6 40.0 

lBased on an estjmated 1,155,900,000 visits made to all 

officelbased physicians in 1975 and 1976. 

‘Location within a standard metropolitan statistical area 

(SMS.A). Composition of SMSA’S does not reflect 1974 adjustment. 

A majority of visits to orthopedic surgeons 

(58 percent) were made by patients in the age 

group 25-64 years (table 3). Median age for visits 

was about 35 years. 

An estimated 53 percent of visits to 

orthopedic surgeons were made by male patients 

(table 3), a proportion that substantially exceeded the average proportion of male visits 

found in overall office-based practice (40 percent). Indeed, orthopedic surgery is one of the 

‘few specialties where visits by males equaled or 

exceeded visits by females; the other notable 

examples were pediatrics, urology, and cardiovascular disease. 

The 23 percent of visits to orthopedic surgeons made by new patients is relatively high 

Table 3. Number and percent distribution of office visits to 

orthopedic surgeons, and percent distribution of office visits 

to all specialists, by characteristics of the patient: United 

States, 1975-76 

Visits to Visits to 

Pat ient orthopedic surgeons III specialists 

characteristic 

Number in Percent Percent 

thousands distribution iistributionl 

All visits ........... 47,152 100.0 100.0 

— 

Age

Under 15 years ........... 7,747 16,4 18,1 

15-24 years ................. 7,663 16.3. 15,1 

25-44 years ................. 14,313 30,4 25.5 

45-64 years ......... ........ 12,911 27.4 25,1 

65 years and over., ..... 4,519 9.6 16.2 

sex — 

Female...,., ... .. . ... .. . . .. .. . 22,248 47.2 60.4 

Male . .... .. . ..... ... ,.,..,4.,,.. 24,904 52.8 39,6 

Prior visit status 

New patient . ... . .. .. .. . .. .. 10,620 22.5 14.6 

Old patient, new 

problem...,,., .. . .. ..... . . 3,258 6.9 23.2 

Old patient, old 

problem, ........... ........ 33,274 70,6 62,3 

l~ased on an estimated 1.155,900,000 ~isits made ([) al[ 

office-based physicians in 197S and 1976. 

NoTE: Figures may not adti to totals due to rounding. 

compared with ‘the average 15 percent found in 

overall office-based practice (table 3). Cont ributing in large degree to this increased 

presence of new patients is the finding that 7.1 

percent of all visits to orthopedic surgeons were 

referrals from other physicians or agencies —i.e., 

ilmost one-third of the visits by new patients 

were referred visits. This referral rate is considerably larger than the average rate of 2.6 percent 

found for all office-based physicians; indeed, it 

is exceeded by only two other most visited 

specialties–urology and neurology. 

For every visit at which a new problem was 

presented to the orthopedic surgeon (i.e., an~’ 

visit by a new patient or a visit by an old patierit 

with a new problem) there were an average of 

2.4 return visits per year, a return-visit rate that 
admcwMa” 3 

Table 4. Number, percent, and cumulative percent of off ice visits to orthopedic surgeons, by the 10 principal diagnoses most commonly 

rendered by the orthopedic surgeon: United States, 1975-76 

Visits to orthopedic surgeons 

Principal diagnosis and ICDA code 

Number in Cumulative Percent 

thousands percent 

Medical and surgical after~re .......................................... .................... . Y1 O 8,925 18.9 18.9 

Synovitis, bursitis, and tenosynovitis ... ...................... ........................... 731 3,179 6,7 25.6 

Sprains, strains of other and unspecified parts of back . ....... .............. .. 847 2,364 5.0 30.6 

Osteoarthritis and allied conditions ....................... ............................... 713 1,989 4.2 34.8 

Displacement of intervertebral disc ...................................................... 725 1,829 3.9 38.7 

Sprains, s-trains of sacroiliac region ... .................... ............................... 846 1,663 3.5 42.2 

Fracture of radius and ulna ......................................... ......................... 813 1,358 2.9 45.1 

Dislocation of knee .............. ........... ..................................................... 836 1,064 2.3 47.4 

Other diseases of musculoskeletal system, other deformities ................ 738 1,061 2.3 49.7 

Vertebrogenic pain syndrome ............................................................. .. 728 1,031 2.2 51.9 

substantially exceeded the average of 1.6’return 

visits found in overall office practice.2 

Some problem of the musculoskeletal system (e.g., pain, swelling, inju~, etc.) was the 

reason most frequently given by patients for 

visiting the orthopedic surgeon. The largest 

proportion of these complaints or symptoms 

centered on the hip and lower extremity (reported in 28 percent of visits); second in order 

of frequency were problems of the shoulder and 

upper extremity (reported in 25 percent of 

visits); next in frequency were back problems 

(reported in 20 percent of visits); and finally 

were complaints about problems with the face 

and neck (reported in 13 percent of visits). 

Table 4 presents data on the principal 

diagnoses frequently rendered by the orthopedic 

surge on. The principal diagnosis was the firstlisted diagnosis on a survey form that permitted 

up to three diagnostic entries. Diagnostic terms 

and codes are those established by the Eighth 

Revision International Classification of Diseases, 

Adapted for Use in the United States, 1968 

(ICDA). Two major diagnostic groups accounted 

for two-thirds of all the principal diagnoses 

made by the orthopedic surgeon; these were 

“Accidents, . . .. and violence” (36 percent of all 

diagnoses) and “Diseases of the musculoskeletal 

system and connective tissue” (30 percent). 

2T0 obtain this return-visit rate, divide all visits classified as “old patient, old probIem” by visits representing new-problem encounters (i.e., visits by “new 

patient” plus visits by “old patient, new problem”). 

To establish or, more typically, to confirm 

and limit a diagnosis, orthopedic surgeons placed 

chief reliance on two diagnostic procedures—the 

limited examination and the X-ray (table, 5). In 

keeping with the nature of their specialty, they 

used X-ray about five times more frequently 

than the average office-based physician. In 

Table 5. Number and percent of office visits to orthopedic 

surgeons, and percent of visits to all specialists, by selected 

diagnositc and therapeutic services ordered or provided: 

United States, 1975-76 

Visits to Visits to 

SeIcted services orthopedic surgeons II specialists 

ordered or provided Number in Percent Percent 

thousands of visits of visitsl 

Diagnostic service 

Limited history and 

examination .. . ... .. . ... .. 26,019 55.2 51.6 

General history and 

examination . ... .. .. ... . .. 5,142 10.9 16.3 

Clinical laboratory 

test .. .. . .. .... . .. ... . ... .. . .. . 745 1,6 22.8 

X-ray .. .. . ... .. .. ... .. .. .. . . ... 17,086 36.3 7,6 

Blood pressure check.. 690 1.5 33.2 

Therapeutic service 

Drug prescribed ... . . ... .. 8,030 17.0 43.6 

Injection . . ... .. . .... .. . ... .. . 2,998 6.4 13.1 

Office surgery ... .. . ... .. . . 6,748 14.3 6.9 

Physiotherapy .. .. ... .. .. . 4,477 9.5 2.6 

Medical counseling . . .. . 7,766 16.5 13.0 

lBa@ On an estimated 1,1SS,900,000 ViSit5 made to all 

office-based physicians in 197 S and 1976. 
4


Table 6. Number and percent distribution of office visits to 

orthopedic surgeons, and percent distribution of office visits 

to all specialists, by characteristics of the visit: United States, 

1975-76 

Vkit characteristic 

All visits .......... 

Seriousness 

of problem 

Serious and very 

serious ..... ................. 

Slightly serious...,.,, .... 

Not serious ................. 

Disposition 

(se-ens) 

No followup ............... 

Return at specified 

time ......................... 

Return if needed .. ...... 

Referred to other 

physician or agency.. 

Admit to hospital ....... 

Duration 

O minutes (no face. 

to-face contact with 

physician) ................. 

1-5 minutes ................ 

6-10 minutes, ............. 

11-15 minutes ............ 

16-30 minutes ............ 

31 minutes or more,,,. 

Visits to Visits to 

orthopedic surgeons 111specialists 

Number in Percent Percent 

thousands distribution ~istributionl 

47,152 1Oo.c 100.0 

11,203 23.8 19.2 

18,137 38.5 32.3 

17,813 37,.5 48.5 

4,969 10.5 12.3 

31,261 66.3 60.2 

7,695 16.3 21.9 

1,064 2.3 2.8 

1,646 3.5 2.1 

517 1.1 1.8 

7,801 16.6 15.1 

13,672 28.0 31.5 

11,650 24.7 26.6 

11,132 23.6 19.5 

2,378 5.0 5.5 

further contrast with the average experience, 

orthopedic surgeons made relatively less use of 

drugs and injections and relatitrely more of 

manipulative and surgical forms’ of treatment 

(e.g., physiotherapy and such surgical procedures as wound suture, fracture reduction, and 

the application or removal of supportive matenals for fractures and sprains). 

Table 6 presents data on the severity of the 

patient problems presented to the orthopedic 

surgeon. These data express the doctor’s judgment of the extent of impairment that might 

resuh if no care were available. In keeping with 

the average tendency among office-based practitioners, orthopedic surgeons judged most Of 

their patients’ problems (3 of every 4) to range 

from slightly serious to not serious in prognosis. 

Data on disposition (table 6) show that 

scheduled followup—directed after 2 df every 3 

visits-is the rule with office-based orthopedic 

surgeons as it is with all office-based practitioners. Admission to the hospital, though somewhat more common in the office-based practice 

of the orthopedic surgeon than it is in overall 

office-based practice, is still a rare event (3.5 

percent of visits). 

The duration of visit (the portion of an 

office visit that involves face-to-face contact 

between patient and orthopedic surgeon) was 

under 16 minutes for about 70 percent of office 

visits (table 6). Agreeing closely with the finding 

for all office-based practitioners, the average 

face-to-face encounter between patient and 

orthopedic surgeon was probably about 15 

minutes in duration. 

l&sed on an estimated 1.155,900.000 vk.its made to all 

office-based physicitins in 197 S and 1’976; 

NOTE: Figures may not add to totals due to rounding, 
....................................................

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admmdab5 

TECHNICAL NOTES “ 

SOURCE OF DATA: The information presented 

in this report is based on data collected in the 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS) during 1975 and 1976. The target 

population of NAMCS encompasses office visits 

within the coterminous United States made by 

ambulatory patients to physicians not in Federal 

Service who are principally engaged in office 

practice and not in the specialties of anesthesiology, pathology, or radiology. 

SAMPLE DESIGN: NAMCS utilizes a multistage 

probability design that involves samples of 

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within 

practices. Each year a sample of practicing 

physicians is selected from master files maintained by the American Medical Association and 

the American Osteopathic Association. (This 

sample included 136 orthopedic surgeons in 

1975 and 140 in 1976.) These physicians are 

requested to complete Patient Records (brief 

encounter forms) for a systematic” random 

sample of office visits taking place within their 

practice during a randomly assigned weekly 

reporting period. A facsimile of the Patient 

Record used during 1975-76 is shown in a 

previous issue of Advance Data From Vital and 

Health Statistics, No. 12, October 12, 1977. 

Characteristics of the physician’s practice, such 

as primary specialty and type of practice, are 

obtained during an induction interview. A detailed description of the NAMCS design and 

procedures has been published in Series 13-No. 

33, Vital and Health Statistics, DHEW Pub. No. 

(PHS) 78-1784, Public Health Service, Washington, U.S. Government Printing Office, Dec. 

1977. 

SAMPLING ERRORS: Because the estimates 

for this report are based on a sample rather than 

on the entire universe, they are subject to sampling variability. The standard error is primarily 

a measure of sampling variability. The relative 

standard error of an estimate is obtained by 

dividing the standard error of the estimate by 

the estimate itself and is expressed as a percent 

of the estimate. Relative standard errors of 

selected aggregate statistics are shown in table 1. 

The standard errors appropriate for estimated 

percentages of visits are shown in table II. 

Table 1. Approximate relative standard errors of estimated number of office visits: Unitad States, 1975-76 

Estimated number Relative 

of office visits standard error 

in thousands in percent 

600 ......................................................... 30.2 

1,000 . . 23.5 

2,000 . . 16.7 

4,000 . . 12.0 

10,000 . . . . 8.0 

40,000 . . 4.8 

200,000 . . 3.4 

1,000,000 . . 3.1 

Example of use of table: An aggregate estimate of 25,000,000 

visits has a relative standard error of 6.4 percent or a standard 

error of 1,600,000 visits (6.4 percent of 25 ,000,000). 

Table II. Approximate standard errors of percentages of estimated 

number of office visits: United States, 1975-76 

‘ 

~ 

8tandard error in percentage points 

600 .. . .... .. .... . . .... .. . 3.0 6.5 9.0 12.0 13.8 15.0 

1,000 . 2.3 5.1 7.S3 9.3 10.7 11.6 

2,000 . 1.6 3.6 4.9 6.6 7.5 8.2 

48000’ . . 1.2 2.5 3.5 4.7 5.3 5.8 

10,000 . 0.7 1.6 2.2 2.9 3.4 3.7 

40,000 . 0.4 0.8 1.1 1.7 1.8 

200,000 . 0.2 0.4 0.5 ;:; o.8 0.8 

1,000,000 .. . 0.1 S3.2 ().2 0.3 0.3 0.4 

Example of use of table: An estimate of 20 percent based on 

an aggregate estimate of 80,000,000 visits has a standard error of 

1.3 percent. The relative standard error of 20 percent is 6.5 percent (1. 3 percent + 20 percent). 

DEFINITIONS: An anzbzdatmy patient is an 

individual presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any health care institution. 

An oj-j’ice is a place that the physician identifies as a location for his ambulatory practice. 

Responsibility over time for patient care and 

professional services rendered there generally 

resides with the individual physician, rather than 

an institution. 

A visit is a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working, under the ph ysician’s super-
6


vision for the purpose of seeking care and ren- based; physicians who specialize in anesthesidering health services. ology, pathology, or radiology; physicians, who 

A physician is a duly licensed doctor of are federally employed; physicians who treat 

medicine (M. D.) or doctor of osteopathy (D. O.) only institutionalized patients; physicians 

currently in office-based practice who spends employed full time by an institution; and 

time in caring for ambulatory patients. Excluded physicians who spend no time seeing ambulator}” 

from NAMCS are physicians who are hospital patients. 
---

ackmecw7 

SYMBOLS 

Data not available–--—--–------------—-—— 

Category not applicable-----------—------—-- . . . 

Quantity zero----------—–-–--——-—- -

Quantity more than O but less than 0.05-— 0.0 

Figure does not meet standards of * reliability or precision————-——-

Data suppressed to comply with 

confidentiality requirements—---——-— # 
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FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health Service I Number 34 q August 30,1978 

Office Visits to Otolaryngologists: National Ambulatory 

Medical Care Survey, United States: 1975-761 

Based on data from the National Ambulatory Medical Care Survey (NAMCS), this report describes an estimated 27,192,000 visits 

made to the offices of otolaryngologists over the 

2-year span from January 1975 through December 1976. NAMCS is a sample survey designed to explore the provision and utilization of 

ambulatory care in the physician’s office-the 

setting where most Americans seek health care. 

The survey is conducted yearly throughout the 

coterminous United States by the Division of 

Health Resources Utilization Statistics of the 

National Center for Health Statistics. The survey 

sample is selected from doctors of medicine and 

osteopathy who are principally engaged in 

o f fice-based, patient-care practice. Excluded 

from the sample are an indeterminate number of 

physicians who render some office-based ambulatory care but whose patient-care activities are 

secondary to another primary role such as teaching, research, or administration. Also excluded 

from the NAMCS scope are physicians who are 

hospital based; those whose specialty is anesthesiology, pathology, or radiology; and physicians 

in Federal Service. 

Because the estimates presented in this report are based on .a sample rather than on the 

entire universe of office-based physicians, they 

are subject to sampling vanability. See the 

Technical Notes for an explanation and for 

guidelines in judging the relative precision of the 

estimates. The directions offered there also provide the basis for judging the statistical signiflThis report was prepared by Hugo Koch, Division of 

Health Resources Utilization Statistics. 

icance of differences between estimates that the 

reader may desire to compare. 

DATA HIGHLIGHTS 

With an estimated 27,192,000 office Visits 

during the 2-year span 1975-76, otolq-yngologists were among the 13 specialkts who figured most prominently in the provision of 

office-based ambulatory care (see table 1). 

Compared with the entire universe of officebased physicians, otoku-yngologists reversed the 

overall preference for solo over multiple-member 

practice (table 2); well over one-haIf (61 percent) of visits to otolaryngologists were made to 

those in multiple-member practice arrangements. 

Table 1. Number of off ice visits to the 13 most visited specialists, 

by type of specialty in rank order: United States, 1975-76 

Number of 

Rank Type of specialty visits in 

thousands 

General and family practice ....... .... ..... .. 460,297 

Internal mediqine ................................. 130,367 

Pediatrics .............................................. 107,085 

Obstetrics and gynecology ....... ...... ....... 97,070 

General surgery ........ .................. ........... 77,259 

Ophthalmology ..... ........................ ........ 53,959 

Orthopedic surgery .. ............................. 47,152 

Dermtology ................. ...... ...... ..... ....... 35,721 

psychiatry ...................................... ....... 30,616 

Oto.?aryngolOgy ..................................... 27,192 

Urology ...... .................................... ....... 20,728 

Cardiovascular disease ........................... 13,517 

Neurology ... ............................. ............. 3,784 
2 

Table 2, Number and percent distribution of office visits to 

otolaryngologists, and percent distribution of office visits to 

all specialists by physician characteristics: United States, 

1975-76 

Visits to Visits to all 

Physician otolaryngologists specialists 

characteristic 

Number in Percent Percent 

thousands distribution distribution] 

All visits ............. 27,192 100.0 100.0 

Location 

of prect icq 

Metropolitan area2.. 20,502 75.4 73.3 

Non metropolitan 

area .. ... ..... .. .. .... .. .. .. 6,691 24.6 26.7 

Type of practice 

solo .... .... .. .. ..... ... .. .. 10,524 38.7 60.0 

Other ... ..... .. .. .... ... . .. . 16,668 61.3 40.0 

lBased on an estimated 1,155,900,000 visits made to all 

office-based physicians in 1975 and 1976. 

2~cation ~,ithin a standard metropolitan 5tati5tical area 

(S MSA), Co reposition of SMSA’S does not reflect 1974 adjust ments. 

Though otolaryngologists treated patients of 

alI ages, the median visit age of 35 years which 

typified their office-based practice was not substantially different frpm the median visit age of 

37 years characteristic of overall office-based 

practice. Ho\vever, among otolaryngologists, 

there did appear to be a relatively greater concentration of visits (22 percent) by patients 

under 15 years of age (table 3). 

Almost one-half (47 percent) of visits to 

otolaryngologists \vere made by male patients, a 

proportion that somewhat exceeded that found 

in overall office-based practice (table 3). 

The 31 percent of visits to oto]aryngologists 

made by new patients is about twice the comparable proportion found on the average among 

all office-based practitioners (prior-visit status, 

table 3). Indeed, among the most visited specialists (listed in table 1), only neurologists exceeded otolaryngologists in this proportion. 

Contributing in part to this increased presence 

of new patients is the finding that 5.8 percent of 

visits to otolaryngologists were referrals, a referral rate that more than doubled the average 

rate of 2.6 percent common to overaIl officebasecl practice. For the 10,907,000 visits at 

Table 3, Number and percent distribution of office visits to 

otolaryngologists, and percent distribution of office visits to 

ail socialists. bv mtient characteristics: Unitad States, 

197ti-76 ‘ 

Visits to Visits to all 

Pat ient otolaryngologists specialists 

characteristic 

Wmber in Percent Percent 

housands ~istribution distribution] 

All visits .... ......... 27,192 100.0 100.0 

Age

— 

Under 15 years ..... .... 5,967 22.0 18.1 

15-24 years .............. 3,458 12.7 15.1 

25-44 years .......... .... 7,434 27.3 25.5 

45-64 years .............. 6,623 24.4 25.1 

65 years and over..., 3,710 13.6 16.2 

— 

Sex 

Female ............ ...... .. 14,412 53.0 60.4 

Male.., ................’..... 12,781 47.0 39,6 

Prior-visit status 

New patient ... . .. ... . .. . 8,471 31.2 14,6 

Old patient, new 

problem . .. . .... .. .... . . . 2,436 9.0 23.2 

Old patient, old 

problem ... . . .... .. .. ... . 16,285 59.9 62.3 

l~~ed on an ~qimated 1,155,900,000 VkitS made to a]] 

office-based physicians in 1975 “and “1976. 

which a new problem was presented to the 

otolaryngologist (i.e., 8,471,000 visits by ne~v 

patients plus 2,436,000 visits by old patients 

with new problems), there were 16,285,000 

return visits, an average of 1.5 return visits per 

new’ problem per year, a return-visit rate that did 

not differ substantially from the average of 1.6 

return visits found in overall office practice. 

Table 4 sho~vs the 10 complaints or symptoms that most frequently prompted a visit to 

the otolaryngologist. The terms and codes applied to these symptoms or complaints are those 

developed for use in the N.4MCS.2 

2National Center for Health Statistics: The National 

Ambulatory Medical Care Survey: Symptom classification, United States. Vital and Health Statistics. Series 2-

No. 63. DHEW Pub. No. (HRA) 74-1337. Health 

Resources Administration. Washington. U.S. Government Printing Office, h4ay 1974. 
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dumCeCw3 

Table 4. Number, percent, and cumulative percent of office visits to otolaryngologists, by the 10 most common complaints or’ symptoms 

presented by-patients, classified by NAMCS codes and ranked by frequency of visits: United States, 1975-76 

Rank 

.— 

Complaint or symptom and NAMCS code 

Earache ....... .......... .......................................... ............................ ...................... 735 

Hearing dysfunctions other than dwfnew ........................ ................................. 731 

Ear symptoms n.e.c. (e.g., foreign body in ear, itching, swelling, or mass) ........ 740 

Sore throat . ........... ................ ........ ....................... ........... .......... ............. .......... 520 

Nasal congestion ............... .......... ............. ............ ............................................. 301 

Pain~awelling, injury of face and neck region ............................. ....................... 410 

Plugged feeling in ear ..... ............................................................. .......... ............. 737 

Headache ......... ............ ...... ............................. ................................................... 056 

Sinus problems ................................................................ .................................. 304 

Vetiigo ................... ..... ..... ............ .............................................. ....................... 069 

Number of Percent CumulsKiv< 

visits in 

thousands of visits percent 

2,853 10.5 10.5 

.2,339 8.6 19.1 

2,195 8.1 27.2 

2.018 7.4 34.6 

1,624 6.0 40.6 

1,028 3.8 44.4 

1,010 3.7 48.1 

723 2.7 50.8 

717 2.6 53.4 

660 2.4 55.8 

The complaints that patients presented to 

of fice-b ased otolaryngologists signaled conditions of illness or injury that were about 

equally divided between acute problems, defined 

for NAMCS use as conditions having an onset 

within 3 months of the visit, and chronic problems, defined as preexisting conditions having an 

onset of 3 months or more before the visit. (In 

overall office-practice, visits for acute problems 

outnumbered those for chronic problems by a 

ratio of about 1.2 to 1.) Only urologists and 

dermatologists exceeded otolaryngologists in the 

proportion of visits classified as “chronic problem, flare-up ,’3 that is, sudden exacerbation of a 

preexisting chronic condition. An estimated 19 

percent of the otolaryngologist’s visits fell into 

this category. The overall average for officebased practice was about 11 percent. 

Table 5 presents data on the 10 principal 

diagnoses most frequently rendered by the 

off i c e-based otolaryngologist. The jwi?~cipai 

diagnosis was the first-listed diagnosis on a survey form that permitted up to three diagnostic 

entries. Table 6 classifies all principal c?iagnoses 

made by otolaryngologists by major diagnostic 

groups. Diagnostic classes and codes are those 

established by the Eighth Reui.~ion Intmno tional 

Classification of Diseases, Adapted “for L-SC i?; 

the United States, 1968 (lCDA). 3 

3ATational Center for Health Statistits: .Eight)s R cvisiorz Internu tio ml Clmsificat io n of Diseases, Adapted 

for Use in the United States. PHS Pub. !XO. 1693. Pubiic 

Health Service. M@hihgton. U.S. Government Printing 

Office, 1968. 

Table 5. Number, percent, and cumulative percent of office visits to otolaryngologists, by the 10 principal diagnoses most frequently 

renderad by the-physicians in rank order: United States, 1975-76 

Number of Percent cumulative Rank Principal diagnosis and ICDA code visits in of visits percent thousands 

Dtitis media ..................................... ............ ............................................... .......38l 

Medical and surgical aftercare ..... .............................. .................................. .......Y1 o 

Other diseases of ear and mastoid process ................................ ........................ . 387 

Dtitis externa ............... ............... ....... ................................................................ 380 

Hay fever ........................................................................ ............................ ....... 507 

Deafness, other than deaf mutism ................................. ............ .........................389 

Chronic sinusitis ............................ ..................................... ............ .................. ..5o3 

Hypertrophy of tonsils and adenoids ....... .................................................. ...... ...500 

Chronic pharyngitis and nasopharyngitis .................................................... ........5O2 

Othar diseases of respiratory symem ... ...............................................................SO8 

3,518 12.9 12.9 

2,394 8.8 21.7 

2,038 7.5 29.2 

1,787 6.6 35.8 

1,637 6.0 41 .s 

1,276 4.7 46.5 

1,122 4.1 50.6 

999 3.7 54.2 

851 3.1 !57.4 

768 .2.8 60.2 
4


Table 6. Number and percent distribution of office visits to 

otolaryngologists, by major diagnostic group: United States. 

1975-76 

Number of Major diagnostic group Percant 

visits in and ICDA codes distribution 

thousands 

All diagnostic groups .. ........... 27,192 100.0 

Infective and parasitic 

diseases .. . .. .... .. .. .. ... .. .. ... . .. 000-136 504 1.9 

Diseases of the nervous system and 

sense organs .. . ... .. ..... .. ... .. . 320-389 10,497 38.6 

Diseases oft he respiratory 

system .. ... . .... ... .. .. .... . . .... .. 460-519 8,716 32.1 

Diseases of the digestive 

system ... ... .. .. .. ... .. .. ... .. .. ... 620-577 588 2.2 

Diseases of the skin and 

subcutaneous tissue .. .. .. ....6BO-709 479 1.8 

Symptoms and illdefined 

conditions ...... ... .. ... .. ... . .. ..78O-796 1,782 6.6 

Accidents, poisonings, and 

violence .. . .... .. ... .. .... ... .... .. 800-999 469 1.7 

SLwcial conditions and exami. 

nations without sickness..YOO-Yl 3 2,682 9.9 

Residual ..... .. .. ... ... .. ... ... ... .. ... . ... .. ... . . 1,466 5.2 

Table 7. Nutier and percent of office visits to otolaryngologists, 

therapeutic services provided: 

Diagnostic and therapeutic services provided 

No services provided ............................................................ .................... .................................. . 

To establish a diagnosis, office-based 

otolaryngologists relied chiefly on a Iimited history and examination (table 7), that is, one 

focused on the body sites specific to their professional perspective and concerned primarily 

with the patient’s chief complaint (e.g., earache 

or sore throat). Use of laboratory tests and 

blood pressure checks was minimal compared 

with the average use of these diagnostic procedures in overall office-based practice, Drug 

therapy was the treatment most frequently protided by otoIaryngologists, who used it in about 

48 percent of visits, a proportion that roughly 

paralleled its use by the average office-based 

physician. The use of minor surgical procedures 

in the office of the otoku-yngologist (in about 12 

percent of visits) substantiaHy exceeded the 

average use of office surgery in overall office 

practice (table 7). 

Table 8 offers data on the severity of the 

problems that patients presented to the otolaryngologist, expressing the doctor’s judgment 

of the extent of impairment that might result if 

no care were available. Closely paralleling the 

and parcent of office visits to’ all specialists, by diagnostic and 

United States, 1975-76 

Visits to all, Visits tootolaryngoloists spatial ists 

Number of 

visits in Percant Percentl 

thousands 

Diagnostic services: 

Limited history or examination .................. ........................... ......................................... ...... 

General history or examination .......................... .................................................................. 

Clinical lab test ..................................................................................... ...... .......................... 

X-ray .......................................................... .............. ........................................................ .... 

Blood pressure check ................................................................................. ........................... 

Hearing test ........................................... ............. ........................................... .......... .. ...... ..... 

Vision test ............................................. ..................................................... ....... .................... 

Therapeutic services: 

Drug prescribed .... ........................................................................... ...... ...... .............. ........ .... 

Injection ........................................... ..................................................................................... 

Immunization or desensitization” ...... ....................... ................... ...... ............ .................... ..... 

Dffice surgery .................................................. ................... .............................................. ..... 

Medical counsel ing ...................... .......................................................................................... 

Dther services provided ................................................................................ ......................... ..... 

1,337 4.9 2.5 

15,166 55,8 51.6 

2,884 11,0 16.3 

762 2,8 22.8 

1,636 6,0 7.6 

496 1.8 33.2 

3,54a 13.1 1,3 

782 2.9 5,0 

12,955 47.6 43.6 

2,428 8.9 13,1 

627 2.3 4.9 

3,150 11.6 6.9 

2,871 10.6 13.0 

1,754 6.5 5.6 

lBa~ed on an ~~imated 1,155,900,000 visits made to all office-based physicians in 1975 and 1976. 
dacedaa5 

Table 8. Number and percent distribution of	 office visits to otolaryngologists, and percent of office visits to all specialists, by selected 

visit characteristics: United States, 1976-76 

/isits to otolaryngologists 

Visit characteristic 

Number in Percent 

thoucands distribution 

All visits ............................................................................... ............................................. d=27,192 100.0

/isits to all 

special ists 

Percent 

distribution 

100.0 

19.2 

32.3 

48.5 

12,3 

60.2 

21,9 

3.5 

2.8 

2.1 

1.8 

15.1 

31.5 

26.6 

19.5 

5.5 

serious and very serious ................................................................................ .................. ............ 

Slightly serious ................................ ........... ............... ................................................. ..... ............ 

Not serious ......................... ........................ ...............................m................................................. 

Disposition (selected actions) 

No followp ....................... ........ ................................ ........................... .................... .................. 

Return at specified tim .............................. .............................................................. .................. 

Return if needd ...................................................................... ........ ........................................... 

Telephone followp ..................................................... .................................................... ........... 

Referred to other physician or agency .................. ................................ ...................................... 

Admit to hospital ........................................................ ................................................................ 

Duration of visit 

O minute (no face-to-face encounter with physician) ............................................................... .... 

1-5 minutes ........................................... ................ .......................... .................... ........................ 

6-10 minutes ... ........................................................................... ...... ............. .............................. 

11-15 minutes ................................... .............................................. ............. .................... ........... 

16-30 minutes .......... ............................. .............. ....................... ................................................. 

31 minutes or mre ................... ............ ...................................................................................... 

lBased on an estimated 1,155,900,000 visits made to all ofice-based physicians in 1975 and 1976. 

4,934 18.2 

10,286 37.8 

11,972 44.0 

3,913 14.4 

13,661 50.2 

7,225 26.6 

682 2.5 

�458 �1 .7 

1,170 4.3 

“434 �1 .6 

3,796 14.0 

10,222 37.6 

6,377 23.5 

5.735 21.1 

630 2.3 

average tendency among all office-based practitioners, otolaryngologists judged most of their 

patients’ problems (about 4 of every 5) to range 

from slightly serious to not serious in prognosis. 

Otolaryngologists ended 1 of every 2 visits 

by scheduling a return visit at a specified time– 

their single, most frequent form of disposition 

(table 8). In their reliance on specific followup 

they were in accord with the general tendency 

found in all office-based practice, though they 

used this disposition action with a frequency 

which was substantially less than average, tending to apply with a greater-than-average frequency the nonspecific direction “return if 

needed.” The nonsenous nature of most of the 

otolaryngologists’ office practice is reflected in 

the small proportion of visits that resulted in 

hospital admission. It is noteworthy, however, ~ 

that this relatively small admission rate was still 

more than double the average rate of hospital 

admission found in all office-based practice. 

Three-fourths of visits to otolaryngologists 

involved a doctor-patient contact that was under 

15 minutes in duration, the average contact 

probably lasting about 14 minutes–not substantially different from the average finding for 

all office-based practitioners (15 minutes). 
........................................................

6 

TECHNICAL NOTES 

SOURCE OF DATA. The information presented 

in this report is based on data collected in the 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS) during 1975 and 1976. The target 

population of the NAMCS encompasses office 

visits made within the coterrninous United 

States by ambulatory patients to physicians not 

in Federal Service who are principally engaged in 

office practice, and not in the speciahies of 

anesthesiology, pathology, or radiology. The 

National Opinion Research Center, under contract to the hlational Center for Health Statistics, was the organization responsible for the 

survey’s field operation. 

SAMPLE DESIGN. The NAMCS utilizes a multistage probability design that involves samples of 

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within 

practices. Each year a sample of practicing 

physicians is selected from master files maintained by the American Medical Association and 

the American Osteopathic Association. (For the 

2-year period 1975-76, a total of 149 otoIaryngologists were included in the Sample. 

They achieved a response rate of 83 percent.) 

Characteristics of the physician’s practice, such 

as primary specialty and type of practice, are 

obtained during an induction interview. 

The physicians are requested to complete 

Patient Records (brief encounter forms) for a 

systematic random sample of office visits during a 

randomly assigned weekly reporting penod.4 (In 

the 2-year period 1975-76, sampled otolaryngologists completed a total of 2,786 Patient 

Records.) A detailed description of the NAMCS 

design and procedures has been presented in the 

publication “The National Ambulatory Medical 

Care Survey: 1975 Summary. ”5 

SAMPLINTG ERRORS. Because the estimates for 

this report are based on a sample rather than on 

the entire universe, they are subject to sampling 

variability. The standard error is primarily a 

4A facsimile of the Patient Record appears as Figure I. 

5National Center for Health Statistics: The National 

Ambulatory Medieal Care Survey: 1975 hmnary, 

United States, January-Decernbm 1975. Vitul and Health 

Statistics. Series 13-No. 33, DHEW Pub. (PHS) 78-1784. 

Washington. U.S. Government printing OffisX, Dec. 

1977. 

measure of sampling variability. The relative 

standard error of an estimate is obtained by 

dividing the standard error of the, estimate by 

the estimate itself and is expressed as a percent 

of the estimate. Relative standard errors of selected aggregate statistics are shown in table L 

The standard errors appropriate for estimated 

percentages of visits are shown in table II. 

DEFINITIONS. An ambulatory patient is an individual presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any”health care institution. 

An office is a place that the physician identifies as a location for his ambulatory practice. 

Responsibility over time for patient care and 

Table 1. Approximate relative standard error Of estimated 

nwrberof office visits: United States, 1975-76 

Estimated number of Relative standard 

off ice visits in thousands error in percent 

1 

mo ...........................................................#. 30.2 

l.m . . 23.5 

16,7 

4;wo ........................................................#. 12.0 

lo.wo ........................................................ 8.0 

40,000 ........................................................ 4.8 

m.m ...................................................... 3.4 

}.m.m ................................................... 3.1 

Example of use of table: An afjgregate estimate of 25,000,000 

visits has a relative standard error of 6.4 percent or a standard 

error of 1,600,000 visits (6.4 percent of 25,000,000). 

Table Il. Approximate standard errors of percentages of estirmtad nutier of office visits: United States, 1.975-76 

8ese of percentage Estimated percentage 

nutrkser of visits 

in thousands 1 or 5 or 1 ;;r 2:Ogr 3~;r 50 

88 95 

8tandard error in percentage points 

............................. 3.0 6.6 9.0 12.0 13.8 15.0 

1,Ooo ............... ........... 2.3 5.1 7.0 9.3 10.7 11.6 

2,000 .. .. .. .. .... . ... . .. .. . .... 1.6 3.6 4.9 6.6 7.5 8,2 

4,000 .. ... .... . ... . ... ... . .. .. 1.2 2.5 3.5 4.7 5.3 5.8 

10,000 ........................ 0.7 1.6 2.2 2.9 3.4 3.7 

40,000 ....... ................. 0.4 0.8 1.1 1.5 1.7 1.8 

200,00CL ..................... 0.2 0,4 0.5 0.7 0.8 0.8 

1 ,Ooo,ooo ...... ............. 0.1 0.2 0.2 0.3 0.3 0.4 

— 

timtrk of use of table: An estimate of 20 srercent based on an aggreg;te e~imete-of 80,000,000 visits has a &andard error of 

1.3 percent. The relative standard error of 20 percent is 6.5 

percent (1.3 percent + 20 percent). 
dmcedab7 

professional services rendered there generally 

resides with the individual physician, rather than 

an institution. 

A vis~tis a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working under the physician’s supervision for the purpose of seeking care and 

rendering health services. 

A physician is a duly licensed doctor of 

medicine (MD) or doctor of osteopathy (DO) currently in office-based practice who spends time 

in caring for ambulatory patients. Excluded 

from NAMCS are’ physicians who are hospital 

based; physicians who specialize in anesthesiology, pathology, and radiology; physicians 

who are federally employed; physicians IVIIO 

treat only institutionalized patients; physicians 

employed full time by an institution; and physicians who spend no time seeing ambulato~ 

patients. 

Figure 1. PATlENT RECORD 

ASSURANCE OF CONFIDENTIALITY- All mlormat$on wh=h would rxxmi!IdeMik=lum 01an md’.+dti 

e cmchce.O, m es!abl,sbmen% w!N bc h.!o ccml,drew!, wII be IJS4 omy by pm qaged in w.d 1., 

the rw,pases.1 Ihe SUWCY and wII ..! k d,sclosedor cel.asmd10.llm penoru w used‘c+�m’ O* p-. 

t. OATE OF VISIT PATIENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY .~ 

2. DATE OF BIRTH 4. COLOR OR 5. PATIENT’S PRINCIPAL PFIOBLEMIS) 6. SERIOUSNESS 

B~? 

OF 7. HAvE YOU EVER SEEN 

RACE cOMPLAINT(S). OR sYWTOUIS) w WCII PELOBLEN IN ITEM 5* THIS PATIENT BEFORE? 

m	 : :X., :E”wnw”’ds’ . BLACK IMPORTANT 

f � FEMALE I � OTHER 

2 ~ MALE I . ~z UNKNOWN b, OTHER 

8.	 MAJoR REASON(S) FOR THIS VISIT [cherk ,//major fewom) — 

s,! D ACUTE PROBLEM ., ~ WELL AOULT/CH ILO EXAM 

s>	 IJ ACUTE PROBLEM. FOLLOW. UP ,. ~ FAMILY PLANNING 

,) C CHRONIC PROBLEM. ROUTINE C COUNSELING/AOVICE 

c. ~ CHRONIC PROBLEM, FLARE-UP ,! ~ IMMUNIZATION 

.% � PRENATAL CARE ~. c REFERREO BY OTHER PHYWAGENCY 

., 0 POSTNATAL CARE ,> @ ADMINISTRATIVE PURPOSE 

:, z POSTOPERATIVE CARE ,. C OTHER tSPPCJfY] 

7 

(Opcr.+e procedu~e) 

10. DIAGNOCTIC~HERAPEUTIC SERVICES OROEREO/PROVIOED THIS VISIT (Chrckd/ti#Y) 

01 � NONE 11 D DRUG PRESCRISEO


02 � LIMITEO HISTORY)EXAM 12 � X.FEAY


03 � GENERAL HISTORYIEXAM 13 D INJECTION


04 D CLINICAL LAB. TEST 1A � !MMUNlZAT10NlDE3 EN31TlZAT1GN


os O BLOOO PRESSURE CHECK 15 ~ PHYSIOTHERAPY


06 •l EKG 16 0 MEOICALCOUN3ELNJG 

07 0 HEARING TEST 17 1=1KYCHOTHERAPY~HERAPEUTIC 

on •l VISION TEST LISTENING 

09 0 ENCOSCOPY 18 E OTHER l.$@cifY) 

,10 D OFFICE SURGERY 

1 

(Check one) 

.nYy :~NO , G VERY SERIOUS 

~ ~ SERIOUS II YES. for the problem 

indicated in ITEM 5a? I � SLIGHTLY SERIOUS 

. C NOT SER1OUS . ~ YES *ENO 

I 

9. PHYSICIANS PRINCIPAL 01A6NOSIS ~ VISIT 

a. OIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY 

b OTHER SIGNIFICANT CURRENT DIAGNOSES 

(in order of importance) 

11. DISPOSITION THIS VISIT 12. OURATION OF 

(Check allfkat z ~ VISIT [Time 

actually spent with 

, b NO FOLLOW-UP PLANNED I physician) 

~ c RETuRN AT SPECIFIEO TIME 

I G RETURN IF NEEDED, P.R.N. 

. ~ TELEPHONE FOLLOW-UP PLANNED 

5 Cl REFERRED TO OTHER —MNWES 

PliYSICIAN~AGENCY 

*	 ~ RETURNEO TO REFERRING 

PHYSICIAN 

? 5 AOMIT TO HOSPITAL 

t C OTHER (Spcci/y) 

H RA-34-3 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE O.?A.B. #6 S-S721G6 

REV. 8-74 WBLIC HEALTH SERVICE EXP1 RATION DATE 12/31/75 HEALTH RESOURCEE ADMINISTRATION 

NATIONAL CENTER FOR HEALTH STATISTICS 
------------------------------------- ---

---------------------------

---------------------------------------------

------

----------------------

8


SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05 0.0 

Figure does not meet standards of * reliability or precision 
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service I Nuqber 35 s September 6, 1978 

An Overview of Nursing Home Characteristics: Provisional 

Data from the 1977 National Nursing Home Survey’ 

This report presents provisional statistics on 

an estimated 18,300 nursing homes in the “coter­ . minous United States. The data are from the 

1977 National Nursing Home Survey (NNHS). 

This nationwide sample survey of nursing 

homes—their residents, their discharges, and 

their staff–was conducted by the National 

Center for Health Statistics from May through 

December 1977. The survey is the second in an 

ongoing NNHS system. The first survey was conducted between Augu’st 1973 and April 1974. 

The estimates presented here are provisional, 

since they are based on a subsample of about 

340 of the 1,700 facilities in the national survey. 

Nursing homes included in the survey were 

those classified by the 1973 Master Facility Inventory (MFI) as nursing care homes, personal 

care homes (with and without nursing), and ,,	 domiciliary c~re homes as well as all nursing 

homes opened for business between the time the 

1973 MFI was conducted and December 1976.2 

This represents a broadening of the scope of 

coverage over that of the 1973-74 NNHS. The 

earlier survey excluded facilities providing only 

personal care or domiciliary care. Since the impact of including these facilities in the 1977 

NNHS is expected to be small (they comprised 

1This report was prepared by Mark R. Meiners, formerly with the Division of Health Resources Utilization 

Statistics. 

*lNational Center for Health Statistics: Inpatient 

health facilities as reported from the 1973 MFISurvey, 

by A. Sirrocco. Vital and Health Statistics, Series 14N0. 

16. DHEW Pub. No. (HRA) 76-1811. Health Resources 

Administration. Washington. U.S. Government Printing 

Office, May 1976. 

only about 2 percent of all nursing homes in the 

1973 MFI and housed only about’1 percent of 

the beds and residents), no special adjustments 

are made in this report when comparing data 

from the 1977 NNHS with the 1973-74 NNHS. 

Provisional estimates of the characteristics of 

residents and discharges are presented in Advance Data Number 29.3 

The focus of this report is facility characteristics with the estimates presented by type of 

ownership, certification status, facility bed size, 

and geographic region. Estimates of the number 

of facilities; beds, residents, full-time equivalent 

employees, and the average monthly charge are 

based on 1977 data and reflect the situation on 

any day during the su~ey period. Estimates of 

the annual occupancy “rate, median duration of 

stay, admissicms, discharges, resident days, and 

cost per resident day are for 1976. In most cases 

they reflect the calendar year, although for the 

latter two types of estimates fiscal year data 

were acceptable. 

The sample design for the 1977 NNTHSwas a 

stratified two-stage probabilityy sample. The first 

stage was a selection of facilities and the second 

stage was a selection of residents, discharges, and 

staff from the sample facilities. Data on the 

characteristics of the facility were collected by 

interviewing the administrator. Data on costs 

were obtained from the facility’s account ant, 

.%National Center for Health Statistics: A comparison 

of nursing home residents and discharges from the 1977 

National Home Survey: United States, by E. Hing and 

A. Zappolo, Advance Data from Vital and Health Statktics, Number 29, DHEW Pub. No. (PHS) 78-1250. Public 

Health Service. Hyattsville, Md., May 17, 1978. 
� � 

2


who completed the questionnaire and returned 

it by mail. Data for a sample of residents on the 

facility’s roster at the time of the survey were 

collected by interviewing the nurse most familiar 

with the care provided to the resident. When 

necessary, the nurse referred to the resident’s 

medical record. Data for a sample of discharges 

in 1976 were also collected by interviewing the 

nurse most familiar with the medical record of 

the discharged resident. Data on a sample of employees were collected by leaving a questionnaire for the sampled person to complete and to 

return by mail. 

Since all the estimates are based on a sample 

of nursing homes rather than on a complete 

enumeration, they are subject to sampling variability. Information on sampling variability is 

presented in the Technical Notes. 

FACILITY 

CHARACTERISTICS 

For the period May to December 1977, the 

provisional national estimates indicated some 

18,300 nursing homes had a totaI of 1,383,600 

beds and served 1,287,400 residents (table 1). 

Proprietary ownership continued to be 

dominant in the nursing home segment of the 

health care delivery system with an estimated 74 

percent of the facilities operated for profit. Although the nonprofit and Government nursing 

homes comprised only about 26 percent of the 

facilities, their greater capacity (average size 97 

beds compared to 68 beds for proprieta~ facilities) enabled them to seine as a partial offset to 

the difference in the number of residents sened. 

About 34 percent of all residents were served by -

Table 1. Provisional number and percent distribution of nursing homes, beds, and residents, by selected nursing home characteristics: 

United States, 1977 

Nursing homes Beds 

Nursing home characteristics 

Percent Percent 

Number Number distribution distribution 

All nursing homes.,.., .......... ............................. 

Ownership 

Proprietary ............................................ ..................... 

Nonprofit and Govern merit...............,....,........,....,.,.,. 

Certification 

Skilled nursing facility ................................................ 

Skilled nursing and intermediate care facility ..,......,,.. 

Intermediate care facility .... ....................................... 

Not certified ............................................................ ... 

Bed size 

Less than 50 b4s .................. ..................... ................ 

50-99 beds ........................... ....................... ................ 

100.199beds ....................... .............. ............... .......... 

200 beds or mre .................................. ..................... 

Geographic region 

18,300 

13,600 

4,700 

3,600 

3,900 

6,200 

4,600 

7,800 

5,200 

4,600 

4,300 

58800 

4,200 

4,000 

100.0 1,383,600 100.0 

7’4.3 926,100 66.9 

25.7 457,600 33.1 

19.9 271,700 19.6 

21.1 484,300 35.0 

33.7 455,700 32.9 

25.3 171,900 12.4 

42.5 205,700 14.9 

28.5 376,600 27.2 

24.9 590,600 42.7 

210,800 15.2 

23.4 302,100 21.8 

31.8 472,300 34.1 

22,9 404,000 29.2 

21.9 205,300 14.8 

Residents 

Percent 

Number ~istribution 

1,287,400 100.0 

I 

851,7001 66.2 

435,700, 33.8 

\ I 

252,100 19.6 

462,200 35.9 

414,300 32.2 

158,800 12.3 

193,500 15.0 

353,000 27.4 

547,400 I 42,5 

193,500 ~ 15.0 

274,600 21.3 

446,700 34.7 

377,800 29,3 

188,300 14,6 

NOTE: Figures may not add to totals due to rounding. 
nursing homes operated under nonprofit or 

Government auspices. 

Nursing homes can also be classified according to their certification status. Facilities in the 

1977 NNHS were comprised of 

. Those certifitid as skiIIed nursing facilities (ShTF’s) by Medicare (Title X17111 

of the Social Security Act). 

. Those certified as SNF’S by Medicaid 

(Title XIX of the Social Security Act). 

. Those certified as intermediate care facilities (ICF ‘s) by Medicaid (Title XIX of 

the Social Security Act), and 

. Those not certified by either program. 

The ShTF regulations were identical under 

Medicare and Medicaid and nursing homes could 

be certified under both these programs. Furthermore, nursing homes that were certified could 

be certified under both the SNF and ICF regulations. 

About 75 percent of the nursing homes in 

the 1977 NNHS were certified either as SNF’S, 

ICF’S or both. The largest share of the certified 

facilities (45 percent) were certified only as 

ICF’S. Facilities certified as both an SNF and an 

ICF were larger (124 beds per facility) than the 

other facilities. They comprised about 21 percent of all the nursing homes but housed about 

35 percent of the beds and 36 percent of the 

residents. hlursing homes which were not certified by Medicare or Medicaid were generally 

small, averaging about 37 beds per facility. 

These facilities comprised about 25 percent of all 

nursing homes but housed only about 12 percent of the beds and resident:. 

The distribution of facilities, beds, and residents by bed size and geographic region is also 

presented in table 1. 

Employees 

The employee data in this report are presented in terms of full-time equivalent (FTE) employees. Thirty-five hours of part-time employees’ work are conventionally taken as 

equivalent to one full-time employee. Part-time 

emulovees were converted to FTE employees by 

div~di~g the number of hours worked-by’ 35. B~7 

using the number of FTE employees rather than 

total employees, the variation between facilities 

in the proportion of part-time staff is held constant. The procedures used to estimate the number of FTE empIoyees differed slightly from 

those used in the previous NNHS in that the 

1977 estimates are based on a sample of employees from each sample facility while the 

1973-74 estimates are based on all staff in each 

sample facility. Although the effect on the estimate is not expected to be great, this caveat of 

the data should be recognized. 

The employee survey covered individuals 

employed full-time, part-time, or under contract who provided direct or health-related services to nursing home residents. This group 

consists of nursing, administrative, medical, and 

therapeutic personnel. ClericaI, food service, 

housekeeping, and maintenance personnel as 

well as any other employee not performing nursing, administrative, medical or therapeutic 

functions were not surveyed. 

In 1977 there were an estimated 624,600 

FTE employees providing direct or heaIth 

related services to nursing home residents (table 

2). This was about 45 employees per 100 beds. 

The majority of this group (66 percent) were 

employed as nurses’ aides. An additionzd 13 percent were licensed practical nurses; 11 percent 

were administrative, medical, or therapeutic personneI; and 10 percent were registered nurses. 

Differences in staffing patterns are most 

noticeable on the basis of certification status. 

Nursing homes certified by Medicare or Medicaid to provide skilled nursing care had significantly more employees per 100 beds than the 

other types of facilities. The SNF-only group 

had about 59 FTE employees per 100 beds to 

provide health-related services and the SNF and 

ICF group had about 48 lWE employees per 100 

beds. In contrast, nursing homes certified only 

as ICF’S had about 38 employees per 100 beds 

and the nursing homes not certified had about 

35 employees per 100 beds. 

Utilization 

The most important single measure of nursing home utilization from the standpoint of nursing home administrators is probably the occupancy rate. In 1976 the Nation’s nursing homes 

used about 90 percent of their available bed 
� 

4


capacity to provide an estimated 440,195,000 

days of care (table 3). Although this does not 

represent a statistically significant change from 

the 87 percent occupancy rate of 1972, the 

,num.ber of days of care provided during 1976 

increased by about 19 percent. .41s0 during 1976 

an estimated 1,112,000 residents (81 per 100 

beds) were admitted for care and 973,000 (71 

per 100 beds) were discharged. Most of these 

people (74 percent ) were discharged alive to 

either a private or semiprivate residence or, more 

commonly, to another health facility. (See Advance Data NTumber 29 for more detailed estimates of the characteristics of discharges.) 

Caution is recommended when comparing 

estimates of admission with estimates of discharges from the 1977 NNHS, since the procedures for collecting these statistics differed. ‘lllc 

number of admissions in 1976 was determined 

by directly asking the administrator for this information. Estimates of the number of discharges and their characteristics were made from 

a sample of the patients formally discharged 

from the nursing home during 1976. The sunq. 

Table 2. Provisional number and rate per 100 beds of nursing home full-time equivalent (FTE) employees, by occupational categories and 

—, 

Nursing home 

characteristics 

All eh-ployees2 ................ 

Ownershi~ 

Proprietary ........................... . 

Non!xofit and Government ,... 

Certification 

Skilled nursing facility ............ 

Skilled nursing and intermediate care facility ...... ....... 

Intermediate care facility ........ 

Not certified .............. ............. 

Bed size 

Less than 50 beds .................. 

50-99 beds ............................. 

100-199 beds ............ .............. 

200 or more beds .................... 

Geographic region 

Northeast ..... .. ........ ...... ........... 

North Central ........ ................. 

South ............... .. ................ ..... 

West ... ...................... ............... 

selected nursing home characteristics: United States, 1977 

Occupational category of employee 

All FTE 

employeesl Administrative, 

medical, and 

therapeutic F 

Total 

Number Rate Number Rate Number Rate 

624,600 45.1 6B,400 T+4.9 556,200 40.2

395,700 42.7 39,100 4.2 356,600 3B .5 

228,900 50.0 29,300 6.4 199,600 43.6 

158,900 58.5 17,000 6.3 141$00 52.2 

233,900 48.3 21,500 4.4 z12,300 43,8 

172,600 37.9 20,600 4.5 152,000 33.4 

59,300 34.5 9,300 5.4 50,000 29.1 

103,100 50.1 1 B,200 8.9 84,800 41.3 

173,000 45,9 17,200 4.6 155,800 41.2 

262,800 44.5 24,200 4.1 238,600 40.4 

85,700 40.7 8,800 77,000 36,5 

153,300 50.7 17,800 5.9 I 35,500 44.8 

220,300 46.6 24,300 5.1 196,000 41.5 

159,600 39.5 15,100 3.7 144,600 35.8 

91,400 44.5 11,300 5.5 80,200 39.1 

Nurs 19 

-

Registered practical Nurses’ aide nurse nurse 

Jumber Rate Number ?ate Number Rate 

60,700 4.4 82,700 6.0 412,800 

— 

— 

34,300 3.7 54,600 5.9 267,700 28.9 

26,400 5.8 28,200 6.2 145,100 31.7 

21,000 7.7 19,600 7.2 101,300 37.3 

25,200 5.2 28,800 5.9 15s,400 32.7 

9,700 2.1 26,700 5.9 115,600 25.4 

4,800 2.8 7,6Q0 4.4 37,600 21.9 

9,400 4.6 14,200 6.9 61,200 29.7 

15,300 4.1 21,400 5.7 119,000 31.6 

25,400 4.3 36,500 6.2 176,700 29.9 

10,500 5.0 10,500 5.0 55,900 26,5 

21,800 7.2 20,800 6.9 92,900 30.7 

19,100 4.0 24,200 5.1 152,700 32.3 

9,200 2.3 27,100 6.7 108,200 26.8 

10,500 5.1 1O,EWO 5.1 59,100 28.8 

— 

135 hours of pat.time emp]oyee5) work is considered equivalent to one full-time employee. Part-time emplOYeeS were converted to 

full-time equivalent employees by dividing the number of hours worked per week by 35. 

2*nclud-es on] ~ ~m ~lo yeeS providingdirect health-related services to reaid ents. 

NOTE: Figures may not add to totals due to rounding. 
.

dwlcdaa5 

of discharges represents an addition to the earlier 

IWHS design and provides the information 

necessary to determine the duration of a completed nursing home stay. For those discharged 

in 1976, the median duration of stay was 84 

days or 12 weeks. 

Nursing home utilization patterns are particularly influenced by certification status. The 

regulations distinguishing ShTF care and ICF care 

foIlowed different models. SNF care is oriented 

to rehabilitation (the medical model adapted to 

a less intensive need for services than is present 

in hospitals). ICF care is oriented to maintenance (the health care related service model 

with emphasis on personal rather than medical 

care). 

The effect of this difference on duration of 

stay and patient turnover rates is significant. 

Nursing homes certified only as SNF’S had a substantially shorter median duration of stay (39 

days) than did nursing homes certified only as 

ICF’S (181 days). In addition, nursing homes 

certified onIy as SNF’S had 133 admissions and 

about 116 discharges per 100 beds, while nursing homes certified only as ICF’S had about 59 

admissions and, 54 discharges per 100 beds. 

-, ... . . ,. “ “-J%-( Table 3. Selected provisional measures of nursing home utilization, by selected nursing home characteristics: United ?tates, 1976 -,- t - . . .- — -

Discharges 

Admissions 

Median Total 

Resident Annual hwation 

Nursing home characteristics days in ccupancy )f stay ir Rate Rate 

thousends ratel days Number per Number per in 100 in 100 

housand! beds :housands beds 

Total .......................................... 440,195 89.6 84 1,112 81.4 973 71.2 

Ownership .. 

Proprietary ..,.., .. .. .... ................... ...... 293,071 90.2 ‘ 89 778 85.2 686 75.1 

Nonprofit and Govern merit.,.., ........ 147,124 88.6 65 334 73.7 287 63.4 

Certification 

Skilled nursing facility .. .. .. .. .. .. ... . .. .. . 87,419 91.3 39 357 33.0 310 15.7 

Skilled nursing and intermediate care facility ... .. .. .... ... ... .. ... . 158,452 90.1 83 400 83.2 335 69.7 

Intermediate care facility .. .. .. .... . . .... . 

Not certified ... .. .. ... . .. .. .. . ... .. . ... .. .. .. .. . 

138,541 

55,783 

88.1 

89.7 

181 

94 

260 * 58.5 � 

240 * 53.8 

51.5 

Bed size 

Less than 50 beds ... . ... .. .... .. .. .. .. .... . ... 65,194 90.5 65 140 68.1 134 65.2 

50-99 beds .... . .. ... .. .. .. . . .... . . .... .. .... . ....’ 127,146 93.6 73 283 76.1 252 67.7 

100-199 beds ... ... . .. .... .. .. .. .. ... . .. .... .. .. 181,411 86.8 72 532 92.2 449 77.9 

200 beds or more .. ... ... .... .. .. .. . . .... . . ... 66,443 89.6 188 157 74.4 137 65.0 

Geographic region 

Northeast ............ .... .......... ............... 99,972 88.6 86 237 78.5 204 67.7 

North Central ..... ........ ...... ...... ...... .... 152,361 91.9 116 313 66.9 271 58.0 

South ...... ............ ............ ...... ...... ..... 121,956 87.8 96 290 74.2 252 64.4 

West ....... .............................. ...... ...... 65,90ii 89.5 43 272 32.6 246 19.7 

1 ~ ~gregate number of days of care provided to residents in 1976 x 100 

Z Estimated number of beds in 1976 x 366 

NOTE: Figures may not add to totals due to rounding. 

Live 

Rate Number ‘ercent 

in 17; of 

10usands beds total 

. -1- 722 52.9 74.2 

508 55.7 74.1 

214 47,3 74.6 

247 92.2 79.8 ‘ --< 

237 49.3 70.7 

173 38.7 72.1 + � . 

17; 48.; 71.; 

333 57.8 74.2 + * + 

\

\ 

145 47.9 70.7 

193 41.2 71.1 

172 44.1 68.5 

213 103.6 86.5 
Cost of Providing Care 

In 1976 the Nation’s nursing homes spent an 

estimated $10.6 billion providing services to 

their residents. This amounted to a cost per resident day of $24.04, the majority (59 percent) of 

which went for labor costs (figure 1). Operating, 

fixed, and miscellaneous costs accounted for an 

additional 22 percent, 15 percent, and 5 percent 

of the total, respectively. Although the total 

cost per resident day for all nursing homes was 

$24.04, only about 30 percent of the facilities 

had an average cost of $25.00 or more (figure 2). 

Another 32 percent of the facilities had an average cost of less than $15.00 per resident day. 

e’ The pro~dures for collecting the cost data 

in th g. ~j Y7 NNHS differed somewhat from 

those used in the 1973-74 NNHS. i~l the earlier 

survey the Expense Questionnaire was only 

given to those facilities in business for 2 years 

or more; in the current survey all facilities 

received the Expense Questionnaire. The effect 

of this change on the cost per resident day estimates is minimal, however, since the 1976 total 

cost per resident day for nursing homes in business 2 years or more was $23.86. Therefore 

there is little problem with direct comparisons 

between the estimates for 1972 and 1976. DurFigure 1. PROVISIONAL AMOUNT AND PERCENT DISTRIBUTION 

OF TOTAL COSTS PER RESIDENT DAY TO NURSING 

HOMES BY MAJOR COMPONENTS: UNITED STATES, 1976. 

MISCELLANEOUS COSTS 

Total casts per residenl day to nursing homes S24.04 

Figure 2. PROVISIONAL PERCENT DISTRIBUTION OF NURSING 

HOMES BY TOTAL COST PER RESIDENT DAY: UNITEO 

STATES, 1976. 

40 

r 

I 

TOTAL COST PER RESIOENT OAY 

ing this period the average cost to nursing homes 

of providing care increased 45-46 percent, a rate 

exceeding, the general inflation rate of 36 percent ind;cated by the U.S. Bureau of Labor 

Statistid’ Consumer Price Index. However, it is 

in line with the 46-percent increase in the hospital service charges component of that index. 

The basic patterns of variability in average total 

cost by ownership, certification, size, and region 

found in the previous NhTHS are substantiated 

by the 1976 data. Total cost per resident day 

tends to be highest in nonprofit and Government 

facilities, in facilities certified only as”SNF’S, in 

facilities with 200 beds or more, and in facilities 

located in the Northeast (table 4). 

Presented along with the cost data in table 4 

is some information, not collected in the previous NNHS, concerning the distribution of resident days of care among the alternative certificate ion programs. These data highlight the 

substantial involvement of the Medicaid program 

in the financing of nursing home care. About 60 

percent of all the days of care provided in 1976 

were financed either totally or partially by the 

h4edicaid program (22.5 percent under the SIYF 

regulations and 37,2 percent under the ICF re~llations). These data, along with the national 
� � 

� 

� 

� 

� 

� 

� 

� 

� � 

Table 4. Provisional total cost per resident day to nursing homes, number, and percent distribution of resident days by type of 

certification. accordina to selected nursirw home characteristics: United States, 1976 

All nursing 440,195

Resident days by type of certification 

Total Resident Medicaid 

Nursing home characteristics cost per 

esident day 

days in 

:housands Tota I 

Skilled nursing facility intermediate 

Not 

certified 

care Medicara Medicaid facility 

homes .................. .......... ......... $24.04 1100.0 2.4 22.5 37.2 38.0 

Ownership . 

Proprietary . .. .... .. .... .. .. .. .... . .. .. . .. .. . . .... .. .... . . .... .. . 22.32 293,071 100.0 23.5 37.8 37.0 

Nonprofit and Government .... . . ... . ..... . .. .. .. .. .. .. . 27.52 147,124 100.0 20.5 36.0 39.8 

certification 

Skilled nursing facility ..... .. .... . . ... . ... V. .. .. .. .. .. .. . 33.80 87,419 100.0 56.7 . . . 38.9 

Skilled nursing and intermediate care facility.. 25,75 158,452 100.0 ‘B 32.7 36.7 26.5 

Intermediate care facility ... ... .. . ... . .. .. .. .. .. . . .... .. . 19.44 138,541 100.0 . . . . . . 72.1 27.9 

Not certified ..... .. .. .... . . .... .. .. .. .. .... .. .. .. .. ... . .. .. .. .. 15.59 55,783 100.0 . . . . . . . . . 100.0 

8ed size 

Less than 50 beds .... .......... ...... .... ................ .... 21.58 65,194 100.0 34.0 52.4 

50-99 beds ........ .......... ............ .......... .. ............ 22.18 127,146 100.0 16.0 40.5 42.1 

100-199 beds .. .. .. .. .... .. . ... . . .... . . ... . .. .. .. .. ... . .. .. . ... 23.64’ 181,411 100.0 26.0 36.3 35.5 

200 beds or more . . ..... . . ..... .. ... .. . ... . .. .. .. .. ... . .. ... . 31.08 66,443 100.0 35.0 36.3 � 

Geographic region 

*

Northeast ................... ...... ...... ................ ......... 36.1”7 99,972 100.0 31.4 30.4 33.1 

North Central .......................... ..... ................... 19.30 152,361 lCJ).O 16.4 41.2 40.8 � * South ....o....... ..... .................... ............ ............. 19.37 121,956 100.0 49.3 35.0 

West .... ...m........................................................ 25.68 65,906 100.0 37.3 44.2 

NOTE: Figures may not add to totals due to rounding. 

health expenditure estimates from the Social 

Security Administration, indicate that in 1976 

the Medicaid program spent approximately 

$20.41 per resident day on nursing home care 

while the Medicare program spent approximately $28.87.4 Although the resident days of 

care not financed by either Medicaid or Medicare are in the minority, they do represent a 

substantial proportion (38 percent) of all days. 

At least a fourth of all the days of care 

provided in the certified nursing homes were not 

financed by Medicaid or Medicare. For facilities 

4Gibson, R. M, and”Mueller, M. S.: National Health 

Expenditures, Fiscal Year 1976. Social Security Bulletin, 

HEW Pub. No. (SSA) 77-11700. April 1977. 

.-

certified only as SNF’S the proportion was about 

39 percent. 

Charges for care 

FaciIity-related information concerning the 

chaxges made to residents for their care is presented in table 5. In 1977 the average total 

monthly ckwge was estimated to be $669. 

About 11 percent of the residents had monthly 

charges of less than $400 and about 25 percent 

were charged $800 or more per month. One of 

the most noticeable differences in these data is 

that the average charge to residents in nonprofit 

and Government nursing homes ($7 22) appears 

to be higher than the average charge to residents 

I 
� � 

� � 

� 

8


in proprietary nursing homes ($641). Although 

the provisional standard errors of these estimates 

are such that the difference is not statistically 

significant, the data do imply a different relationship than was found in the 1973-74 NNHS. 

In the earlier sumey, residents in proprietary 

facilities had higher monthly charges, on the 

average, than those in the nonprofit and Government facilities. The change is likely to be related 

to the fact that the disparity in costs between 

the profit group and the nonprofit and Government group has widened and the decreasing impact of donations and subsidies has necessitated 

more reliance on user charges by nonprofit and 

Government nursing homes. The data on charges 

also show that it continues to be substantial}’ 

more costly for residents using nursing homes in 

the Northeast than in any other area of the 

country. The average monthly charge for residents in Northeastern nursing homes was $864 

compared to art average of $614 to $643 in the 

other regions. 

Table 5. Provisional average total monthly charges for care in nursing homes, number of residents, and percent distribution Of 

residents by monthly charge intervals, according toselected nursing home characteristics: United States, 1977 

Nursing home characteristics 

All residents ...... ......... ................ 

Ownership 

Proprietary ................. ........ .... .. .... .... 

Nonprofit and Government ..... .. ....... 

Certification 

Skilled nursing facility ....... .............. 

Skilled nursing and intermediate care facility ...... .............. 

Intermediate mre facility .......... . .... 

Not certified ................ .................... 

Bed size 

Less than 50 beds..., ........................ . 

,50-99 beds ......... ................ .............. 

100-199 beds .......................... ......... 

200 beds or more ....... ............ ......... 

Geographic region 

Northeast ................................. ........ 

North Central ............... .................... 

South ................. .................... .. .. ...... 

West ............. ................ ...... ........ ...... 

I 

Average Nugpar 

Monthly charges 

total 

chargel residents Total ~Jk~o~&or *$399 $400.$59 ~oo.$799 $800 Or more 

Percent distribution of readients 

641 851,700 100.0 � 11.5 34.4 

Y

31.2 20.4 

722 435,700 100.0 � 10.5 25.7 26.2 33.3 

852 252,100 100.0 14.0 31.0 I 46.6 

752 462,200 100.0 � � 21.7 39.0 I 32.9 

1,287,400 100.0 3.1 11.2 31.4 

565 414,300 100.0 � 8.6 55.2 24,5 9,2 . 409 158J300 100.0 � 44.3 25.5 12.8 

593 193,500 100.0 � 30.5 23.7 22.4 21.5 

628 353,000 100.0 � 9.9 39.8 31.4 15.5 

689 547,400 100.0 � 6.8 31.5 31.2 27,7 

764 193,500 100.0 � � 23.8 28.7 35.5 

864 274,600 100.0 � � 14.1 20.3 56.3 

614 446,700 100.0 � 13.6 35.8 31.0 18,6 

603 377.800 100.0 47.3 25.4 14.1 

643 188,300 100.0 � 19.1 14.5 47.8 

1Includes Iife.care residents and no-charge residentsbut excludes the residents for whom the ch=ge’s not ‘nown. 

NOTE: Figures may not add to totals due to rounding. 
admcdaa9 

TECHNICAL NOTES 

Since the statistics presented in this report 

are based onasample, they will differ somewhat 

from figures that would have been obtained if a 

complete census had been taken using the same 

schedules, instructions, and procedures. The 

standard error is primarily a measure of the variability that occurs by chance because only a 

sample, rather than the entire universe, is surveyed. The standard error also reflects part of 

the measurement error, but it does not measure 

any systematic biases in the data. The chances 

are about 95 out of 100 that an estimate from 

the sample differs from the value which would 

be obtained from a complete census by less than 

twice the standard error. 

Rather than present specific errors for a 

particular statistic, the provisional approximate 

relative standard errors and standard errors for a 

wide variety of estimates have been provided. 

Provisional estimates of relative standard errors 

for the estimated numbers of admissions, beds, 

residents, discharges, total FTE employees, administrative, medical, and therapeutic FTE employees, RN FTE employees, LPN FTE employees, nurses’ aide FTE employees, and facilities are presented in figure L Provisional relative 

standard errors for resident days are presented in 

figure II, provisional standard errors for average 

cost per resident day are presented in table I, and 

provisional standard errors for average monthly 

charges are presented in table II. 

The relative standard error of an estimate is 

the standard error of the estimate divided by the 

estimate itself and is expressed as a percentage 

of the estimate. In this report, an asterisk is 

shown for any estimate with more than a 25-

percent relative standard error. Because of the 

relationship between the relative standard error 

and the estimate, the standard error of an estimate can be found by multiplying the estimate 

by its relative standard error. For example, curve 

B of figure I shows the relative standard error 

for beds. Table 1 gives the total number of beds 

in all facilities with less than 50 beds as 205,700. 

g 

E 

: 

u~ 

:7 

<~ 

OS 

z 

<, 

Ii 

? 

L 

<z 

-1 

: 

FiiUreL PROVISIONALRELATIVESTANDARDERRORSFORESTIMATEDNUMBERSOF ADMISSIONS, 

BEDS, RESIDENTS, DISCHARGES, FULL-TIME EQUIVALENT HE) EMPLOYEES, ANO FACILITIES 

loos ~loc 

m WI 

70 

m : 

m . 

M 4, 

30 3, 

w m 

lo% ~ 10 

e 

; 

, 

4 

3 3 

1 

l.o~ ~ 1.0 

*	 8 

7 

8 : 

.5 5 

.4 4 

.3 3 

2 2 

.1 -

A 2 3“68’8’A ‘ ‘“’’’”’A ‘ ‘ ““’”i 2 “’’’’’A*”’ 1,m lo,m 1W,ooo 1,003,003 10,003,1XM 

SIZE OF ESTIMATE 
10


Table 1, Provisional standard errors of percentages f Or average cost Per resident day 

Average cost per resident day 

Resident days (base of ratio) 

$1.00 $4.00 

I $8.00 $12.00 $16.00 $20.00 

I I I 

$30.00 $40.00 

,andard error in dollar 

a.ooo.ooo .. .... .. ........ ...... ...... ................ “0.59 �1.11 1.35 1.79 2.m 2.62 2.84 3.38 

60.000.000 ..... .. ............ ...................... ... ‘0.54 *1 .01 1.23 1,62 1,99 2.36 2.55 304 

70.000.000 .......................... ...... ............ ‘0.50 0.93 1.14 1.49 1.82 2.16 2,33 2.77 

80.W0.000 ............................................ ‘0.46 0,87 1.06 1.38 1.66 1.99 2.15 2.55 

w.ooo.om ........ .................. ...... ...... ...... ‘0.44 0.82 0.99 1.28 1.57 1,85 1.98 2.37 

loo.om.ooo .. ........ .. ............ ...... ............ ‘0.42 0.78 0.94 1,21 1.47 1.73 1.86 2.20 

2oo.ooo.ow .................................... .. .... �0.30 0.54 0.64 0.78 0.91 1.02 1.09 1.25 

3oo.ooo.ow .... ...... .................... ...... ...... 0.25 0.44 0.51 0.58 0.62 0.64 0.64 0.69 

350.000.000 ........................ .................. 0.23 0.41 0.47 0.52 0.52 0.48 0.45 ‘0,46 

1 

The relative standard error corresponding to this Table Il. Provisional standard errors of average monthly charges 

estimate on curve B of figure I is approximately 

14.0 percent. The standard error is 205,700 Number of Average monthly charge 

(.14) = 28,798. residents or 

discharges 

Approximate standard error of ratios such as (base of ratio) 

b400 $500 $600 $700 $800 $900$1,000 

full-time equi~alcnt employees per 100 beds can 

be calculated as in the follo~ving example: Standard error in dollars 

Suppose the standard error (u R,) for the ratio Of 90,000 .... ......... 84 100 116 131 147 1621 178 

total FTE employees per 100 beds is desired for 

nursing homes \vitll less than 50 beds. In table 2 

100,000 ........... 

200,000 ........... 

400,000 ........... 

80 

56 

40 

95 

67 

47 

110 

77 

55 

124 

88 

62 

139 

98 

69 

154 

109 

76 

168 

119 

84 

the total FTE employees per 100 beds for 600,000 ........... 32 38 44 50 56 62 68 

800,000 ........... 28 33 38 43 49 54 59 

1,000,000 ........ 25 30 34 39 43 48 52 

1,200,000 ....... . 23 27 31 35 39 43 4s 

Fqure Il. PROVISIONAL RELATIVESTANOARO ERRORSFOR 

ESTIMATED NUMBER OF RESIDENT DAYS 

homes with :ss than 50 beds is 50.1 ~vhicl] i: 

equal to a total of 103,100 FTE emplo}ees divided by 205,700 beds times 100. The rcla~i~c 

standard error of 103,100 total FTE enlpl(~}des 

is (from figure I, curve D) approximatel~ 8.7 

percent, and the relative standard error of 

205,700 beds (from figure I, curve B) i~ apPr’-)~imately 14.0 percent. The square root (>f the sum 

of the squares of these two relative stand:~r~l 

errors minus their covariance provides an 

4 I L. . 

approximation for the relative standard error of 

the ratio. In other words, if J’x, is the relati~’~ 

,1-,

3 

2 standard error of number of total FTE emI ployees, V’y, is the relative standard error of 

efficient between total FTE employees and beds 1 

?, ‘567BSA 

10 

1 3 . 5678*A 

100 

1 , .56>ne 

1,pm 

I 

A number of beds, r is the sample cot-l-elation coSIZE OF ESTIMATE IN MILLIONS 

(conservatively estimated to be 0.5j and 17R~ is 
----------------------------------------- ---

--------------------------------

------

-----------------------------

amcedab 11 

The relative standard error of the ratio R’=X’/Y’: 

vR#2=vx J2+vy,12rvxr Vy, 

=(.087)2 + (.140)2 -1.00 (.087x .140) 

=.0076 + .0196 - .0122= .0150 

v~, =-=.1225 

The approximate standard error of the ratio 

of total FTE employees per 100 beds may now 

be obtained by multiplying the relative standard 

error by the ratio as done below: 

OR ,=R’ x VR , = 50.1x.1225=6.14 

The sample correlation coefficient (r) for 

calculating the standard error estimates of the 

ratios presented in this report is assumed to be 

zero except in the case of full-time equivalent 

employees per 100 beds, occupancy rate, and 

cost per resident day ratio estimates where the 

correlation coefficient used was .5. 

The Z-test with a 0.05 level of significance 

was used to test all comparisons mentioned in 

this report. Since all observed differences were 

not tested, lack of comment in the text does not 

mean that the 

significant. 

difference was not statistically 

. . . 

. 

o.() 

* 

SYMBOLS 

Data not available 

Category not applicable 

Quantity zero -----------------------------------------------

Quantity more than O but less than 0.05 

Figure does not meet standards of 

reliability or precision 
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health service I Numhr 36 � Auwst 18, 1978 

Contraceptive Utilization in the 

INTRODUCTION 

The data presented in this report are the 

latest nationwide statistics on contraceptive utilization from the 1976 and 1973 National Surveys of Family Growth conducted by the 

National Center for Health Statistics. The data 

were collected by means of personal interviews 

with a multistage probability sample of women 

15-44 years of age in the noninstitutionalized 

population of the conterminous United States. 

Women were eligible for inclusion in the sample 

if they were currently or previously married or 

were never married but had offspring presently 

living in the household. 

The interview focused on the respondents’ 

marital and pregnancy histories, their use of contraception and the planning status of each pregnancy, their intentions regarding number and 

spacing of future births, their use of maternal 

care and family planning services, and on a 

broad range of social and economic characteristics. Between June 1973 and February 

1974, 3,856 black women and 5,941 women of 

others races were interviewed for Cycle I. 

Between January and September of 1976, 2,946 

black women and 5,665 women of other races 

were interviewed for Cycle II. Further discussion 

of the survey design, definition of terms, and 

sampling variability are in the Technical Notes. 

CONTRACEPTIVE STATUS FOR 

CURRENTLY MARRIED WOMEN 

From the 1960’s through the early 1970’s, 

there was increased use of highly effective contraceptive methods by married couples in the 

1This report was prepared by Kathleen Ford, Ph. D., 

Division of Vital Statistics. 

United States: 1973 and 1976’ 

United States,2)3 Tables 1, 2, and 3 present preliminary data from 1976 and data from 1973 

representing the contraceptive status of currently married women all ages 15-44 years, ages 

15-2g years, and ages 30-44, respectively. The 

data show that reliance on nonsurgical methods 

of contraception has decreased while surgical 

sterilization has increased. 

In 1976, 30.2 percent of couples with wives 

aged 15-44 years were considered sterile (table 1). 

This represents a more than 6 percentage point 

increase from 1973 and is due primarily to a 

dramatic increase in surgical sterilization among 

white couples. There was a corresponding net 

decrease from 1973 in the other categories, most 

notably a decline of almost 5 percentage points 

in the proportion using nonsurgical methods of 

contraception. However, about the same percent 

of women at risk of an unplanned pregnancy 

(those not sterile, pregnant, post partum, or 

seeking pregnancy) were using a method in 1976 

as were in 1973, 86.3 percent and 85.9 percent, 

respectively. 

Of the remaining (69.8 percent) currently 

married women, 48,6 percent were contraceptors using methods other than sterilization; 

13.4 percent were pregnant, post partum, or 

seeking pregnancy; and 7.7 percent were classified as other nonusers of contraception, that is, 

neither sterile nor “pregnant, post partum, or 

seeking pregnancy. ” 

2 National Center for Health Statistics: Contraceptive 

utilization among currently married women 15-44 years 

of age: United States, 1973, by Kathleen Ford. Monthly 

Vitat Statistics Report, Vol. 25-No. 7, Supp. DHEW Pub. 

No. (PHS) 75-1120. Public Health Service. Rockville, 

Md. Oct. 4, 1976. 

3Westoff, C. F, and Jones, E. F.: Contraception and 

Sterilization in the United States, 1965-1975. Fare. 

Mann. Perspect. 9 (4): 153-157, 1977. 
2


Table 1. Number of currently married women aged 

Hispanic 

Contraceptive status 

All women ................................................. 

Total ............................................................... 

Sterile couples 

All sterile couples ............................................ 

Fecund couples 

Noncontraceptors: 

Pregnant, post partum, seeking pregnancy ............ 

Other nonusers ...................................................... 

Contraceptors: 

All methods ..................................................... 

Oral contraceptive pill ................................................ 

Intrauterine device ................. .................................... 

Diaphragm ....................................... ........................... 

tindom ................... ............................ ...................... 

1~nclude~ white, black, and other races, 

15-44 and percent distribution by contraceptive status, according to race and 

origin: Unitad %tes. 1973 and 1976 

Tota I‘ White Black Hispanic origin2 

1976 1973 1976 1973 1976 1973 1976 1973 

Number in thouaends3 

27,185 26,646 24,518 24,249 2,144 [ 2,081 I 1,673 / 1,676 

Percent d istribtuion 

100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

30.2 23.8 31.0 24.0 24.3 22.7 20.5 21.6 

1.9 0.9 1.9 0.8 2.6 1.9 1.5 �0.7 

28.3 22.9 28.1 23.1 21.7 20.8 19.0 20.9 

9.0 6.5 9.0 6.6 8,8 6.2 7.8 5.2 

8.2 6.3 8.2 6.3 8.7 6.1 7.0 5.2 

0.8 0.2 0.8 0.3 0,0 0.0 ‘0.9 

19.3 16.4 20.1 16.5 12.9 14.6 11.2 15.7 

9.6 8,6 9.6 8.2 11.0 13.6 7.0 10.7 

9.7 7.8 10,5 8.4 1.9 1,0 4.2 5,0 

13.4 14.2 12.8 14.2 16.6 14.0 20.8 18.9 

7.7 8.7 7.2 7.8 13.5 17.9 10.5 9.7 

48.6 53.2 49.0 54.0 45.4 4.5,3 48.7 49.8 

I , 

I 

22.5 25.1 I 22.0 26.3 20.7 

6.1 6.7 6.1 6.6 6.1 7.6 10.4 8.7 

2.9 2.4 3.0 2,5 1.8 1.2 2.4 �1.8 

7.2 9.4 7.4 9.9 4.5 3.2 6.1 7.0 

3.0 3.5 2.9 3.5 3.8 3.0 3.5 *1.8 

3.4 2.8 3.5 2.9 1.4 0,7 3.1 2.1 

2.0 1.5 2.0 1.6 1.8 0.4 �1.1 2.2 

73.7 0.6 0.5 0.5 2.7 1.8 �oel ‘0.6 

22.3 25.1 1---122.9 

0.9 1.3 0.9 1.3 1.2 1,0 �0.5 2.7 

2w0 men Of Hispanicorigin are included in the figures for white and black women if theywereidentifiedas suchby the interviewer. s In the 1973 figures, estimates of the number of women included cases for which contraceptive status was’ not ascertained but was 

imputed. Only those cases in which contraceptive status wms ascertained are included in the 1976 figures. 3ee Technical Notes. 

According to preliminary data for 1976, 

changes since 1973 k the distribution of women 

among categories of contraceptive status were 

largely in the same direction in the age groups 

15-29 years (table 2) and 30-44 years (table 3). 

Both groups experienced a net increase in the 

percent sterile and a net decrease in the percent 

using a method other than sterilization. The net 

increase for women 15-29 years of age was 

approximately 2 percentage points. The net increase was approximately 10 percentage points 

for women 30-44 years of age, and the net decrease was approximately 6 percentage points. 

The proportions of women at risk of an unplanned pregnancy who were using a contraceptive method were practicaHy unchanged 
achwdaa3 

within age groups for the 3 years-for women 

15-29 years of age, 91.9 percent in 1973 and 

91.3 percent in 1976; for women 30-44 years of 

age, 80.3 percent in 1973 and 80.7 percent in 

1976. 

The women in the younger age group who 

were not using a contraceptive method were 

more likely to be pregnant, post partum, or 

seeking pregnancy; the older women were more 

likely to be sterile. The total avoidance of contraception (other nonusers) was greater among 

older women, resulting in a higher percent of 

older women unprotected against an unplanned 

pregnancy. However, it is likely that other 

factors such as lower fecundity and less frequent 

intercourse reduce the risk of pregnancy. 

The percent of wives 30-44 years who were 

pregnant, post partum, or seeking pregnancy increased about 4 percentage points from 1973 

among black wives but did not change among 

white wives. Most of this increase was due to 

black wives ~eporting that they were seeking pregnancy. 

. In 1976 as in 1973, black wives were more 

likely than white wives to fall into the category 

“other nonusers,” although the gap between the 

two groups decreased from 10.1 percentage 

points in 1973 to 6.3 percentage points in 1976. 

The large increase in the percent sterile 

among couples with wives 30 years or oIder is 

due almost entirely to th’e increase among white 

couples. The percent sterile among the black 

couples, wife 30 and over, remained essentially 

constant at about 35 percent in the 2 years, 

while the percent sterile for white couples in this 

age group increased about 10 percentage points 

to 46.8 percent in 1976. Among couples, wife 

15-29, the percent sterile increased about the 

same amount in both racial groups (2.5 and 2.7 

percentage points among white and black 

couples, respectively), remaining slightly higher 

among white couples (11.8 percent) than among 

black couples (10.9 percent). 

The net effect of all these changes, in terms 

of exposure to unpkmned pregnancy, is a lessening of differences between the two racial groups. 

In both years, the proportion of women at risk 

of an unplanned pregnancy who were using a 

contraceptive method was higher for white 

women than for black women, but this percent 

increased for bIack women between 1973 and 

1976 and remained stable for white women. 

About 87 percent of white women at risk of an 

unplanned pregnancy were using a method in 

1973 and 1976, and the percent of black women 

at risk of an unplanned pregnancy who were 

using a method rose 5.4 percentage points to 

77.1 percent in 1976. Parallel trends can be observed for the younger and older age groups. 

Sterility 

In the 30.2 percent of couples in which one 

spouse was sterile, only 1.9 percent were not 

surgically sterile as shown in table 1. Of the remaining 28.3 percent who were surgically sterilized, 9.0 percent reported this to be for non: 

contraceptive reasons and 19.3 percent reported 

this to be at least partly for contraceptive 

reasons. 

Although the nonsurgically sterile accounted 

for ordy 1.9 percent of sterile couples in 1976, 

this was double that proportion for 1973. The 

frequencies are too small for reliable detailed 

study but may reflect better diagnosis of infertility problems. 

The surgically sterile accounted for nearly all 

of the sterile couples, and the increase of 5.4 

percentage points in this group from 1973 to 

1976 acounted for most of the 27-percent increase in overall sterility between these years. 

For white couples with women of all ages 

combined, the percent surgically sterile increase 

6 percentage points from 23.1 percent in 1973 

to 29.1 percent in 1976. In contrast to this, ve~ 

little change occurred in the percent of surgically 

sterile black couples, 20.8 percent in 1973 to 

21.7 percent in 1976. 

For couples where the wife was under age 

30, (table 2) the level and trend of surgical sterilization was similm for white and black couples. 

The percent of white couples, wife 15-29 years, 

who were surgically sterile increased 2.0 percentage points to 10.8 percent in 1976. The 

corresponding figure for black couples rose 1.1 

percentage points to 9.2 percent in 1976. 

Among the white couples, wife aged 30-44 

(table 3) the increase, in surgical sterilization in 

the 3 years between the surveys was most 

dramatic. There was an increase of almost 10 

percentage points from 35.0 in 1973 to 44.2 

percent in 1976. In contrast to this, the percent 
-j 

4


Table 2. Number of currently married women aged 15-29 and percent distribution by contraceptive status, according to race and 

Hispanic origin: United States, 1973 and 1976 

GJntracept ive status 

All wmen .................................................. 

Total ................................................................ 

Sterile couples 

All sterile couples ............................................ 

Mnsurgiml .........c................ .................. ................... . 

Wrgiml ................................ ......... ...........................c. 

Noncontraceptive ............. .................................... 

Femle ................................................ ............ 

"Mle ................................................................ 

tintraceptive . ................c..................................... 

Female .................................................. .......... 

hle ................................... ........ ... ...............i.. 

Fecund couples 

Noncontraceptors: 

Pregnant, post partum, seeking pregnancy..., ......... 

Other nonusers ................................. .................... . 

COnt raceptors: 

All methds ................................... .................. 

Oral contraceptive pill .................................... ............ 

Intrauterine device ....... ......................... ..................... 

Diaphragm ...................................... ........................... 

Gndom ... ............................ ...................................... 

Foam .............................................. ........................... 

Rhythm ...................................................................... 

Withdrawal ................................................................. 

Muche ...................................................................... 

~her ......................................................................... 

1Includes white, black, and other races. 

. 

Totall White Black Hispanic 0rigirr2 

1976 1973 1976 1973 1976 1973 1976 1973 

Number in thousands3 

12,292 \ 12,040 11,063 10,963 978 964 \ 810] 770 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100,0 100.0 

11.6 9.2 11.8 9.3 10.9 8.2 �5.7 10.6 

1.0 ‘0.5 1.0 0.5 1.6 �0.1 

10.6 8.7 10.8 8.8 9.2 8.1 �5.7 10.6 

2.2 �0.8 2.2 �0.8 3.8 �1.4 ‘0,8 

1.9 “0.7 1.8 ‘0.7 3.8 “1.4 �0.8 

‘0.3 �0.1 �0.4 ‘0.1 

8.3 7.9 8.6 8.0 5.4 6.7 �4.9 10.6 

4.4 4.1 4.3 4.0 5.3 6.2 “2.8 “7,1 

3.9 3.7 4.3 4.0 “0.2 “0.4 �2.1 *3.6 

22.5 23.0 22.0 23.0 24.3 22.8 31.7 26.1 

5.7 5.5 5.2 4.9 9.7 12.0 �4.2 �6.2 

60.2 62.3 61.0 62.7 55.1 57.0 58.4 57.0 

35.1 37.6 35.4 37.4 33.8 40.7 31.2 33.0 

6.9 8.4 7.0 8.4 5.4 8.4 10.9 10,8 

2.7 1.7 2,9 1.8 “0.8 ‘0.8 �2.3 *1.3 

6.5 7.0 6,7 7.4 5.0 �1.9 �6.8 �4,9 

3.3 3.6 3.4 3.8 3.0 2.2 �3.4 *1.2 

2.6 1.4 2.6 1.4 �1 .9 �1 .0 �2.O �1,1 

1.7 1.0 1.7 1.1 �1.6 �0,3 �1.5 �2.6 

“0.4 ‘0.3 40.3 ‘0.2 2.4 �1.3 ‘0.7 

“0.9 1.1 “0.9 1.2 �1.O �0.3 �0.3 *1.4 

2Women of Hispanic or~~ are ~cluded in the figures for white and black women if they were identified as such by the interviewer. 

‘In the 1973 figures, estimates of the number of women incIuded 

inputed. Only those cases in which contraceptive status was ascertained 

of surgically sterile black couples, wife aged 

30-44, was stable at about 32 percent both in 

1973 and 1976 and was 12 percentage points 

below that for white couples in 1976. 

The percent of sterilizing operations performed on the male partners remained at about 

cases for which contraceptive status was not ascertained but was 

are included in the 1976 figures. See Technical Notes. 

38 percent for white couples over the 3 years 

but was very small for black couples both in 

1973 and 1976. 

The majority of sterilizing operations were 

reported as contraceptive in intent (table 1). The 

proportion of couples who reported a sterilizing 
acklceM.5 

Table 3. Number of currently married women aged 3044 and percent distribution by contraceptive status, according to rata and 

Hispanic origin: United States, 1973 and 1976 

Total 1 White Black Hispanic origin2 

Contraceptive status 

1976 1973 1976 1973 1976 1973 1976 1973 

Number in thousends3 

All women .............. .................................... 14,882 14,606 13,454 13,286 1,167 1,117 862 [ 806 

Percent distribution 

100.0 Ia).o 100.0 100.0	 I 100.0 100.0 100.0 100.0 

t 

Sterila couples 

All sterile couples............................................ 45.7 36.0 46.8 & 35.2 34.5 30.9 

Nonsurgical ... . .. .... . . ..... . . .... ..!...... . ... .. .... . . .... .. .... .. .. ... ... 2.6 1.3 2.6 1.1 3.4 3.4 �3.O 1.3 

Surgiwl ... . .. .... . . ... . .. ..... .. .. .. ... . .... . .. .. .. . ... . ... ... .. . .. .... ... .. . 43.0 34.6 44.2 35.0 32.2 31.8 31.5 28.6 

Mncontraceptive ... .. ..... . .. ... .. .... . .. .. . ... ... .. .. .. .. . .... . . 14.6 11.3 14.6 11.4 13.0 10.3 14.4 9.6 

Femle ....................... ..................................... 13.5 10.9 13.4 11.0 12.9 10.2 12.7 9.6 

Male ..............................................................0. 1.1 +0.4 1.2 � 0.4 ‘0.1 �0.1 �1.7 

Contraceptive ................. ................ .. ..... ............... 28.4 23.4 29.6 23.6 19.2 21.5 17.1 20.0 

Femle ................ ................... ......................... 14.0 12.2 14.0 11.6 15.9 20.0 10.9 13.8 

Mle .............................................................. .. 14.5 11.1 15,5 12.0 3.4 �1.5 �6.1 �6.2 

Fecund couples 

Noncontraceptors: 

Pregnant, post par-turn, seeking pregnancy ............ 5.9 7.0 5.3 6.9 10.2 6.4 10.6 12.8 

Other nonusers.................... ..............!.... .... .......... 9.3 11.3 8.8 10.2 16.8 23.1 16.5 12.5 

COntraceptors: 

All methods .... .. . .... .. .. ... . . .... .. . .. .. . ... .. . .... .. . .. ... . . 39.1 45.7 39.1 46.8 37.4 35.3 38.4 43.7 

Oral contraceptive pill .... .. . .... . . .. .. .. . ... . . ... ... . .. .. . ..... . .. . 11.8 14.8 11.9 14.9 ‘ 12.2 13.8 11.0 14.4 

Intrauterine device . .. ... . ... .. ... . .. . .... .. . ... .. . .. .. .. ... .. .. .. . ... . 5.4 5.2 5.3 5.2 6.6 7.C 9.8 �6.9 

Diaphragm . . . .. . .... .. ..... . . ... . .... ... . .. . ... .. .. . .. ... . .. . ... . . .... . .. .. 

@ndom . .. ... .. .. .... . . ... ... .... .. .. . ... . .. .. . .. .. ... . .. ... ..... .. .... . ... . 

3.1 

7.7 

2.9 

11.4 

3.1 

8.0 

3.1 

12.0 

2.5 

4.1 

�1.E 

4:3 

�2.E 

�5.5 

�2.2 

8.7 

Foam . ... ... ... ... . ... .. . ... .. . ..... . . .... . . ..... .. .. .. .. ... .. . .... . . ... . .. ... 2.8 3.4 2.6 3.3 4.5 3.7 �3.6 �2.3 

Rhythm . .. ... .... .... . .. .. ... . ... .. . ... ... .. .. .. . .. .. .. ... . .. ... .. .... .. .. .. 

Withdraw l .. . .. ... .. .. ... .. . ... . ... ... . .. ... .. . ... . .. .. ... ..... . . ..... .. .. 

4.0 

2.3 

3.9 

1.8 

4.2 

2.3 

4.1 

2.0 

�1.0 

2.0 

�().5 

�()-E 

�4.2 

‘0.8 

�2.9 

�1.9 

Muche .. .. ... .. . ... .. . ... ... . .... . .. ... .. .... .. . ... .. . .... . . ... .. .. ... .. . ... ‘0.9 ‘0.8 �0.8 ‘0.7 3.0 2.2 �0.2 �0.5 

~her ... . ... ... .. .. .. .. .. .. ... .... .. .. ... ... ... . ... . ... . ... .. .. ... . . ..... . . ... “0.9 1.4 � 0.9 1.5 �1.4 �1.5 *0.6 +3.7 

l~ncludeS white, black, and other races.


2women of ffisp~ni~ origin are included in the figmes for white and black women if they were ident~led as such by the interviewer.


~In 1973 fi~ureS, e5timates of the number of women included cases for which contraceptive status WSS not ascertained but 

was imputed. Only those cases in which contraceptive status was ascertained are included in the 1976 fiiures. See Technical Notes. 

operation performed for noncontraceptive reasons, however, increased 2.5 percentage points 

from 1973 to 9.0 percent in 1976. The proportion of couples who reported a sterilizing 

operation for contraceptive reasons increased 

2.9 percentage points to 19.3 percent in 1976. 

Sterilizing operations were classified as contraceptive or noncontraceptive according to a 

question regarding the contraceptive intent of 

the operation. The wording of this question 

differed for the 2 data years. This wording 

change affected response to the question, in 

. 
6


most cases, lowering the percent of operations 

reported as contraceptive in 1976 relative to 

1973. If the assumption is made that the percent 

of women having a surgical sterilization operation solely for medical (noncontraceptive) reasons should not change for the two surveys, then 

the percent of total women contraceptively 

sterile would be 2 to 3 percent higher in 1976 if 

the 1973 figures are taken as the standard. Conversely, if the percent of surgical sterilization for 

noncontraceptive reasons in 1976 is taken as the 

standard, the percent contraceptively sterile 

would be 2 to 3 percent lower in 1973. The 

motivation behind a sterilizing operation is a complex topic which is presently being studied. A 

more detailed report on contraceptive practices in 

the United States will examine this topic more 

closely. -

Oral Contraceptive Pill 

The increase in the use of oral contraceptives 

observed from the 1960’s through 1973 has 

come to a halt. However, for couples in which 

one partner was not sterile, no other method 

comes close to it in popularity. 

The percent of married women aged 15-44 

using the oral contraceptive pill in 1976 was 

22.3 percent compared with 25.1 percent in 

1973 (table 1). Although this represents a net 

decrease of almost 3 percentage points, the percent of contraceptors using the pill remained 

relatively stable, 46 percent for 1976 and 47 

percent for 1973 (table 4). 

Among the younger wives (15-29 years) in the 

sample, a 2-3 percentage point decline from 

about 37 percent to about 35 percent occurred 

among the total sampled and white women 

(table 2). A larger decline, about 8 percentage 

points, occurred among the young black wives 

from 40.7 percent in 1973 to 33.8 percent in 

1976. As a share of ill contraceptive method use 

other than sterilization for wives under 30, this 

represents about a 2 percentage po@t decline 

from about 60 to about 58 percent for white 

women and total women (table 5) and a 10 percentage point decline from 71.4 percent in 1973 

to 61.4 percent in 1976 for black women. 

Table 4. Number of currently rtmrriad women aged 15-44 using contraceptives other than sterilization and percent distribution by 

method of contraception, according to race and Hispanic origin: United States, 1973 and 1976 

— 

Totall White Black Hispanic origin2 

CZmtraceptive status 

1976 1973 1976 1973 1976 1973 1976 1973 

Number in thousands3 

All wmn .................................................. 13,225 14,183 12,005 13,094 975 944 804 ] 835 

Percent distribution 

Total ......... ...................... ................................. 100.0 100.0 100.0 100.0 100.0 100,0 100.0 100.0 

Oral contraceptive pill ................................................ 46.0 47.2 45.9 46.5 48.5 57.9 43.2 46,0 

Intrauterine device ..................................................... 12.5 12.5 12.4 12.3 13.4 16.9 21.5 17.4 

Diaphragm .................................................................. 6.0 4.5 6.2 4.7 3.9 2.7 �5.1 �3.6 

tindom .................................................... ....... .......... 14.8 17.6 15,1 18.4 9.9 7.1 12.8 14,0 

Withdrawl .................................. ....................... ........ 4.2 2.8 4.2 2.9 4.0 ‘0.9 *7.3 �3.6 

Foam ....................................... ................................... 6.2 ~ 6.5 6.0 6.5 8.4 6.7 ‘6,5 *4,2 

Rhythm ........................................................... ........ ... 6.9 5.3 7.1 5.4 3.1 �1.7 �2.4 “4.5 

Douche .................................................... ........ ........... 1.5 1.1 1.1 “0.9 6.0 4.0 *o .2 *1,2 

1.9 

.— 

Oher ....................................... ...................................

T2.4 1.9T2.5 2.7T2.1 *1.O +5.3

—— 

l~nclude~ white, black, and other races.


2Women of ~i5D”anic origin are included in the figures for white and black women if they were identified as such by the interviewer.


31n ~~, ~ figu;e~, e~timate~ of the number ~f women in~luded cases for which COrStE3CeptiVe StahS was not ascertained but


was imputed. Only those cases in which contmceptive status was ascertained are included in the 1976 figures. See Technical Notes. 
~7 

Table 5. Number of currently married women aged 15-29 using antreceptives other than sterilization and percent distribution by 

method of contraception, according to race and Hispanic origin: United States, 1973 and 1976 

Total’ White Black Hispanic origin2 

Contraceptive status 

1976 1973 1976 1973 1976 1973 1976 1973 

Number in thousands3 

All women ............................................ ...... 7,405 ] 7,501 1] 6,7441 6,8791 5381 549 I 474 I 439 

Percent distribution 

Total ..... ........................................................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Oral contraceptive pill .. ... . .... . .. ... . .... .. ... . ... ... . .... . ... .... . . 58.3 60.4 58.0 59.6 61.4 71.4 53.3 57.9 

Intrauterine device .. ...... . .. ... .. . ... .. . .. .. .. .. .... .. .. .... . ... ... .. . 11.5 13.5 11.5 13.4 �9.8 14.7 18.7 18.9 

Diaphragm ... ... . .... . .. ..... ... .... .. . .. .. . .. .. .... ... .. ... . .... . . .... ... . 4.5 2.8 4.8 2.9 �1 .5 �1.4 +3.9 �2.2 

tindom . .. ... .. .. . ... ... .. ... . .. .. ... . .. .... ... ... . ... .... . ... .... ... .... . .. 10.9 11.2 11.0 11.8 �9.1. �3.4 �11.7 %.7 

Withdrawal . .. .. .... .. .. .... .. .. .. .... .. ... . .. .... . ... .. .. . . ..... . ... ... . . .. 2.8 1.6 2.9 1.7 �2.9 +0.5 �5.8 “2.2 

Foam . .. . .... .... .. .. .... .. ... .. . .. ... .. ..... .. ..... . .. .... .. .. .... . . .... .. ... . 5.5 5.8 5.5 6.0 �5.4 �3.9 �3.4 +1.9 

Rhythm .. .... . ... .... . .. ..... . ... .. ... . ... . .. ..... ... ... .... . .... .. . .. . .. .. .. 4.3 2.3 4.3 2.3 “3.4 �1 .8 �2.6 �4.6 

Douche . .... .. ... .... ... .. ... .. .... .. .. . ... ... . ... .. . ... .. . .. ...... ... .. ... .. . “0.7 “0.6 �0.4 �0.3 “4.4 �2.3 +1.2 

Other .. .. ... .. .. ..... . ... ... .. . . .... .. .. .... .. ..... . . ..... .. ... ... .. . .... . ... .. 1.5 1.8 1.4 1.9 �1 .9 �0.6 �0.6 �2.4 

lIncludes ~hjte, black, and other races.


2W0 men of H15Panic ~rjgin are jncluded ~ the fiugres for white and black women if they were identified as such b Y the interviewer.


31n 1973 figures, estimates of the number of women included cases for which contraceptive status was not ascertained but 

was imputed. Only those cases in which contraceptive status was ascertained are included in the 1976 figures. See Technical Notes. 

For those wives ages 30-44, pill use declined 

about 3 percentage points from about 15 percent in 1973 to 12 percent in 1976 for white 

women and total women (table 3). Pill use 

among older black women declined from 13.8 

percent to 12.2 percent. 

As a proportion of contraceptive method use 

other than sterilization for older women, pill use 

declined only about 2 percentage points for 

white women and total women from about 32 

to about 30 percent (table 6). Among older 

black women, however, the share of contraceptive use other than sterilization for the pill 

declined about 7 percentage points from 39.2 

percent to 32.6 percent. 

Intrauterine Device 

Although it is a highly effective method, the 

intrauterine device (IUD) remained much lower 

in popularity than the pill. In 1973, 6.7 percent 

of wives 15-44 years of age were using the IUD, 

and in 1976 about the same proportion, 6.1 percent, were using this method (table 1). The share 

of method use other than sterilization for the 

IUD remained at 12.5 percent for both years 

(table 4). This method became less popular 

among bl:c,k wives 15-29 years of age over the 

3-year period, 8.4 percent used the IUD in 1973 

and 5.4 percent in 1976 (table 2). 

Condom 

Between 1973 and 1976, use of the condom 

declined about 2 percentage points reducing its 

portion of contraceptive use- other than sterilization from 17.6 percent to 14.8 percent 

(table 4). This small decline is ,present in the 

white and total groups but some increase in condom use is present among black couples in 

which the wife is under age 30 (1.9 percent in 

1973 and 5.0 percent in 1976) (table 2). 

Other Methods 

Use of alI methods other than the pill, IUD, 

or condom continued to be very small. Any increase or decrease in the use of individual 

methods should be interpreted with caution 

because of the small number of sample cases involved. As shown in table 1, there was little 

difference between the 2 years in the percent 
8 

Table 6. Nufier of currently married women aged 30-44 using contraceptives other then sterilization and percent distribution by 

method of contraception, according to race and Hispanic origin: Unitad States, 1973 and 1976 

I I 

Total 1 White Black Hispanic originz 

Contraceptive status 

All women .................................................. 

Total ................................................................ 

Oral contraceptive pill ................................................ 

Intrauterine device ........ .............. .......... ..................... 

Diaphragm ........................... ....................................... 

tindom .... .................................... .. ........................... 

Withdraml ................................................................ . 

Foam ........................................................................ . 

Rhythm ...... ...................................... ......................... 

~uche ...................................................................... 

~her ............................................................... .......... 

1 lncjude~ white, black, and other races 

1976 .1973 1976 1973 

EIE -. I

5,819 I 6,882 

100.0 100.0 

30.3 32.4 

13.8 11.5 

7.9 6.4 

19.8 24.8 

6.0 4.0 

7.1 7.4 

10.2 8.6 I2.4 1.8

2.4 3.1 

Nrsrdmr in thouaands3 

5,260 I 6,215] 436 I 384 J 

Percent distribution 

100.0 ==4=+= 

30.4 31.9 32.6 39.2 

13.6 11.1 17.1 19.9 

8.0 6.6 +6.8 �4.5 

20.4 25.7 � 10.9 �12.1 

5.9 4.2 �5.3 �1.5 

6.6 7.1 �12.1 �1O.6 

10.7 8.8 ‘2.7 �I .4 

2.0 1.5 �8.O �6.4 

2.3 3.1 �3.8 �4.3 

1976 1973 

331 I 396 

100.0 100.0 

28.6 33.0 

25.6 15.8 

*6.8 �5.1 

�I 4.4 20.0 

�9.4 �5.2 

�1O.9 �6.7 

�2.1 �4.3 

�0.6 �1.3 

�1.6 �8.6 

: 

2W0 men of W~Panic origin are in~lud ed in the figures for white and black women if they were identified as such b Y the interviewer. 

31n 1973 figure5, e~timate5 of the number of women included cases for which contraceptive status was not =ertained but 

was imputed. Only those cases in which contraceptive status was ascertained are included in the 1976 fgures. See Technical Notes. 

using methods other than the pill, IUD, and condom among white couples (12.4 percent in 1973 

compared with 13.0 percent in 1976). However, 

the percent of black wives using other methods 

increased from 8.2 percent in 1973 to 12.8 percent in 1976. 

Hispanic Origin 

The large increase in surgical sterilization observed between 1973 and 1976 among the white 

couples in the sample was not present among 

couples of Hispanic origin. Among couples with 

wives reporting Hispanic origin, 21.6 percent 

were surgically sterile in 1973 compared with 

20.5 percent in 1976 (table 1). For 1973 and 

TECHNICAL 

The Survey Design 

The National Survey of Family Growth 

(NSFG) is designed to provide data on fertility, 

family planning, and related aspects of maternal 

and child health. Field work for Cycle I was 

carried out by the National Opinion Research 

1976, about one quarter of the male partners 

among these coupIes were sterile. 

Use of contraceptives by Hispanic couples 

declined from 22.9 percent in 1973 to 20.7 percent in 1976 (table 1). The IUD was more 

popular among women of Hispanic origin than 

all other women in 1973 and in 1976. In 1976, 

10.4 percent of wives of Hispanic origin were 

using an IUD, and in 1973, 8.7 percent of wives 

of Hispanic origin were using an IUD. 

Of those women of Hispanic ongin exposed 

to risk of an unplanned pregnancy (not sterile, 

pregnant, post partum, or seeking pregnancy), 

82.1 percent were using a contraceptive method 

in 1976, compared with 83.7 percent in 1973. 

NOTES 

Center between June 1973 and February 1974. 

Field work for CycIe II was earned out by 

Westat, Inc., between January and September of 

1976. 

A multistage probability sample of women 

in the noninstitutionaIized population of the 

conterminous United States was used in both 
amcdata9 

cycles. Each time, approximately 33,000 households were screened to identify the sample of 

women who would be eligible for NSFG, i.e., 

women between the ages of 15 to 44 years, inclusive, who were currently married or previously married or who were never married but 

had offspring presently living in the household. 

In households with more than one eligible 

woman, a random procedure was used to seIect 

only one to be interviewed. Since the interviews 

were always conducted with ‘the sample person, 

the term “respondent “ is used as synonymous 

with sample person. For Cycle I, interviews were 

completed with 3,856 black women and 5,941 

women of other races. For Cycle H, interviews 

were completed with 2,946 black women and 

5,665 women of other races. A detailed description of the sample design for Cycle I is 

presented in “National Survey of Family 

Growth, Cycle I: Sample Design, Estimation 

Procedures, and Variance Estimation,” Series ,2, 

Number 76, in the Vital and Health Statistics 

series. A similar report is in preparation for 

Cyc]e II. 

The interview was focused on the respondent’s marital and pregnancy histories, on 

the use of contraception and the pkmning status 

of each pregnancy, on the respondent’s intentions regarding the number and spacing of 

future births, on maternal and family planning 

services, and on a broad range of social and 

economic characteristics. While the interviews 

varied greatly in the time required for their completion, they averaged about 70 minutes for 

Cycle I and about 58 minutes for Cycle II. 

Quality control procedures were applied at 

all stages of the survey. These included a veri~ 

fication of listing completeness with unlisted 

dwelling units being brought into the sample, a 

preliminary field review of completed questionnaires for possible missing data or inaccurate 

administration, a 10-percent sample recheck of 

all households to be screened in the suxvey, observation of interviews in the field, and an independent recoding of a 5-percent subsample of 

completed interviews. 

Reliability of Estimates 

Since the statistics presented in this report 

are based on a sample, they may differ somewhat from the figures that would have been 

obtained if a complete census had been taken 

using the same questionnaires, instructions, interviewing personnel, and field procedures. This 

chance difference between sample results and a 

complete count is referred to as sampling error. 

In addition, the results are also subject to nonsampling error due to respondent misreporting, 

data processing mistakes, and nonresponse. It is 

very difficult, if not impossible, to obtain accurate measures of nonsampling errors. These 

types of error were kept to a minimum by the 

quality control procedures and other methods 

incorporated into the survey design and admtilstration. 

Sampling error, or the extent to which 

samples may differ by chance from a complete 

count, is measured by a statistic called the standard error of estimate. Approximate standard 

errors for estimated numbers and percentages 

from Cycle I are shown in tables I and II for the 

total and white populations and in tables III and 

IV for the black population. Provisional estimates for standard errors for Cycle 11 for total 

and white women can be obtained by multiplying the standard errors for these women from 

Cycle I by a factor of 1.1. Similarly, provisional 

estimates of standard errors for Cycle 11 for 

black women can be obtained by multiplying 

the standard errors for these women from Cycle 

I by a factor of 1.2. 

The chances are about 68 out of 100 that an 

estimate from the sample would differ from a 

complete census by less than the standard error. 

The chances are about 95 out of 100 that the 

differences between the sample estimate and a 

Table L Approximate standard errors for estimated numbers for 

white and total women: 1973 National Survey of Family Growth 

Relative size of standard Standard 

estimate error error 

EQloo . ................................. 

100,000................................ 

2CWMCL. .............................. 

500,000................................ 1,Ooo,ooo............................. 

2,000,1Xlo ............................. 

5.000,000 ............................. 

10,000,000 ........................... 

20,000,000 ........................... 

30.0 15,000 

21.2 21,000 

15.0 30,000 

9.5 47,000 

6.7 67,000 

4.8 95,000 

3.0 151,000 

2.2 216,000 

1.5 311,000 
10 dwlncedata 

Table 11. Approximate standard errors for estimated percentages standard error. The relative standard error is the 

expressed in percentage points for white and total women: ratio of the standard error to the statistic being 1973 National Survey of Family Growth. estimated. In this report, numbers and percentages which have a standard error that is 

Estimated percentage more than 25 percent of the estimate itself are 

percentage 50 

considered “unreliable.” They are marked with 

an asterisk to caution the user but may be combined to make other types of comparisons of 

100,000 ... ... ... .. 3.0 4.6 6.4 8.5 9.7 10.4 10,6 greater precision. 

500,000 ... .. . .... 1.3 2.1 2.8 3.8 4.3 4.6 4.7 In this report, terms such as “similar” and 

1,000,000 ... . .... 0.9 1.5 2.0 2.7 3.1 3.3 3.3 “the same” mean that any observed difference 

3,000,000 ... ..... 

5,000,000 .. .. .... 

7,000,0CQ........ 

0.5 

0.4 

0.3 

0.8 

0.6 

0.5 

1.2 

0.9 

0.8 

1.5 

1.2 

1.0 

1.8 

1.4 

1.2 

1.9 

1.5 

1.2 

1.9 

1.5 

1.3 

between two estimates being compared is not 

statistically significant. Similarly, terms such as 

Base of 

10,000,000., .... 0.3 0.5 0.6 0.8 1.0 1.0 1.1 “greater,” “less,” “larger,” and “smaller” in- I I I 1 I dicate that the observed differences are statistically significant. The normal deviate test with a 

.05 level of significance was used to test aJl comparisons which are discussed in the text. A statisTabla II 1. Approximste standard errors for estimated numbers ;ically significant difference is one large enough 

for black women: 1973 National Survey of Family Growth that in repeated samples of the same size and 

type as this one such a large difference would be 

Size of Relative Standard expected to be found in less than 5 percent of 

standard estimate error the samples. Lack of comment in the text error 

between any two statistics does not mean the 

differences was tested and found not to be 

25,000 .................................. 25.3 6,000 significant. 50,000 .................................. 17.9 9,000


100,000 ................................ 12.7 13,000 Adjustment for nonsampling error due to


150,000 ................................ 10,3 16,000 nonresponse was made in two ways. Nonre-


250,000 ................................ 8.0 20,000 spondent cases, as distinct from missing data


350,000 ..,...............,........,,,,. 6.8 24,000


500,000 . ............................... 5.7 28,000 items, were imputed by weighting for non-


750,000 ................................ 4.7 35,000 response within each PSU, stratum, and age-race


1,000,000 ............................. 4,0 40,000 category. In the 1973 survey, codes for missing


items were imputed using a “hot deck” procedure. In the 1976 survey, ;mputation for missing 

data items has not been performed and the figures in the tables are based only on those interTable IV, Approximate standard errors for estimated percentages 

expressed in percentage points for black women: 1973 views where enough informati&-s was obtained 

National Survey of Family Growth from the respondent to determine contraceptive 

status. As a result, in the 1976 figures, about 

Estimated percentage 1,061,000 women out of an estimated 

Base of 31,847,000 total ever-m amied women are, not 

100,000 .... .. ... .. 1.8 2.7 m6<3 Sterile.–A woman (or couple) was classified 

300,000 ...... . .. .. 

500,000......,,.;. 

700,000 ..... . .... . 

1.0 

0.8 

0.7 

1.6 

1.2 

1.0 

2.2 2.9 3.3 3.6 3.6 

1.7 2.3 2.6 2.8 2.8 

2.4 

as sterile if she reported that it was impossible 

for her to have a baby. 

1,000,000 .. . .... . 0.6 0.9 2.0 Nomurgical.–A woman (or couple) was 

classified as nonsurgically sterile if she reported 

percentage 2 or 5 or Oor 200r 300r 40 or 50 represented. 

98 95 90 80 70 60 

—— 

DE FINITIONSOFTERMS 

5,000 ... ..... .. ... .. 7,9 12.3 17.0 22.6 25.9 27.7 28.3 

10,000 ....... ... .. . 5.6 8.7 12.0 16.0 18.3 19.6 20.0 Sterile Couples 

50,000 . .... ... ... .. 2.5 3.9 5.4 7,1 8.2 8.8 8.9 

3.8 5.1 5.8 6.2 
11


that it was impossible for her to have a baby for 

any reason other than a sterilizing operation. Reported nonsurgical reasons for sterility included 

menopause and sterility due to accident, illness, 

or congenital causes. 

Surgical.–A women (or couple) was classified as Surgidiysterile if she or her husband 

were completely sterile due to an operation. 

Since sterilizing operations are very frequ ent 1y obtained exclusively or partly as 

methods of contraception, i.e., because of their 

complete effectiveness against conception rather 

than for purely therapeutic reasons, they have 

been further classified as contraceptive and noncontraceptive. In Cycle I, a sterilizing operation 

wis contraceptive if the respondent answered 

“yes” to the question ‘Was the operation done 

at least partly so that you wouId not have any 

more children?” Since the avoidance of more 

children (conceptions) could itself be for therapeutic reasons, the question was reworded in 

Cycle II to ‘Was one reason for the operation 

because you had all the children you wanted?” 

This change in wording was expected to yield ,a 

lower percent of operations reported for contraceptive reasons than would have been reported previously. As a result, the percents of 

coup 1es with contraceptive and noncontraceptive sterilization shown in this report are not 

completely comparable between the two surveys. Also, there i: evidence that sterilizing 

operations classified as noncontraceptive may include some that actually were at least partly 

contraceptive in intent. The percent classified as 

contraceptive should therefore be regarded as a 

minimum estimate. Because of these limitations 

on the data, sterilizations for contraceptive reasons are reported with other causes or sterility 

and not, as formerly, with other methods of 

contraception. 

Fecund Couples–Noncontraceptors 

Pregnant.–A woman (or couple) was classified as pregnant if she replied affirmatively to 

the question “Are you pregnant now?” or for 

those in doubt, “Do you think you probabIy are 

pregnant or not?” A woman who reported that 

the onset of her last menstrual period was within 

the 30 days prior to the interview was automatically considered not pregnant. 

Seeking pregnancy .-A woman (or couple) 

was classified as seeking pregnancy if she reported she was not using a method at the time 

of interview because she wanted to become 

pregnant. 

Post partum.–A woman (or couple) was 

classified as post partum if she reported she was 

not currently using a method, was not seeking a 

pregnancy, and her last pregnancy had terminated within 2 months before the date she 

was interviewed. 

Other nonusem.-Women (or couples) who 

reported they were currently using no contraceptive method and could not be classified in 

any of the preceding categories of noncontraceptors were classified here. Among these are 

women who were indifferent to the chances of 

pregnancy, had a very low risk of pregnancy due 

to some fecundity impairment, or objected to 

contraceptive methods for personal or religious 

reasons. Women who used the douche following 

intercourse, but who did not report this as a 

method of contraception, were also classified 

here although such douching practice is known 

to have a very modest contraceptive effect when 

done very soon after intercourse. 

Fecund Couples – Contraceptors 

Method users.–A woman (or couple) who 

reported use of a contraceptive method other 

than a surgical sterilization at the date of interview was classified according to the specific 

method used. Methods used by extremely small 

proportions of the population such as jelly, 

cream suppositories, or abstinence, not in combination with any other methods, were grouped 

in the category “Other.” Where more than one 

method was reported in current use, the method 

generaIly considered the most effective was used 

for classification purposes. 

Demographic Terms 

Age.–In this report, age is classified by the 

age of the respondent at her last birthday before 

the date of interview. 

Race. –Classification by race, based on interviewer observation, was reported as black, white, 

or other. Race refers to the race of the woman 

interviewed. 

Hzkpanic origin. –A respondent was classified 

as being of Hispanic origin if she reported her, 

origin or descent as Mexicano, Chicano, Mex-
--------------------------------------- ---

-------------------------------

-----

------------------------------

12


ican American, Puerto Rican, Cuban, or other 

Spanish. 

In tables where data are presented for women according to race and Hispanic origin, 

women of Hispanic origin are included in the 

statistics for white and black women if they 

were identified as such by the interviewer. 

Man”tal status. –Persons are classified by 

marital status as married, widowed, divorced, 

separated, or never married or as informally 

married, such as living with a partner or common-law spouse. Persons who are temporarily 

separated for reasons other than marital discord, 

such as vacation, illness, or Armed Forces, are 

classified as married. Divorced persons are those 

whose most recent marriage has been legally dissolved and who are free to remarry. Women with 

an annulled marriage, while having the legal 

status of never having been married, are classified together with divorced women. The category “separated” includes those who are legally 

or inform a.Ily separated for their most recent 

spouse due to marital discord. The “never 

married” include those who have never had a 

formal marriage and do not consider themselves 

in any of the preceding categories. However, in 

NSFG, only single women with offspring living 

in the househoId are included and separately .-. classified. 

SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero ----------------------------------------------- . 

Quantity more.than O but less than 0.05 0.0 

Figure does not meet standards of 

reliability or precision *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

US DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health Service I Numi)er 87 � August 28,1978 

Office Visits to Dermatologists: National Ambulatory 

Medical Care Survey, United States, 1975-76’ 

This report presents data on office visits to 

dermatologists practicing in the coterminous 

United States. The data presented were collected 

during 1975 and 1976 by means of the National 

Ambulatory Medical Care Survey (NAMCS), a 

continuous survey designed to explore the provision and utilization of ambulatory medical 

care in physicians’ offices and conducted by the 

National Center for Health Statistics. The survey 

sample of physicians was selected from nonfederally employed doctors of medicine and 

osteopathy who are primarily engaged in officebased patient-care practice. It excIudes physicians practicing in AIaska and Hawaii and 

physicians whose specialty is anesthesiology, 

pathology, or radiology. 

The estimates are based on information 

obtained from the “Patient Record” (figure 1), 

an encounter form used by participating physicians to record selected information about their 

office visits. A brief description of the sample 

design and an explanation of sampling errors 

associated with the estimates may be found in 

the “Technical Notes” of this repdrt. A more detailed description of the sample design used in 

NAMCS has been presented in an earlier report.z 

1This report was prepared by Trena Ezzati,’ Division 

of Health Resources Utilization Statistics. 

2Natiori~ Center for Health Statistics: The National 

Ambulatory Medical Care Survey: 1975 summary, 

United States, Januar/-December 1975, by H. Koch and 

T. hlcLemore. Vital and Health Statistics. Series 13-No. 

33. DHEW Pub. No. (PHS) 78-1784. Public Health Service. Washington. U.S. Government Pr.kting OffIce, Jan. 

1978. 

DATA HIGHLIGHTS 

During the 24-month period of January 

1975 through December 1976 an estimated 35.7 

million visits were made to office-based physicians specializing in dermatology (table 1). This 

represents 3.1 percent of the estimated 1.2 

billion ambulatory visits to physicians’ offices 

during this period. “ 

Of the estimated 35.7 million visits to 

dermatologists from Januaky 1975 through 

December 1976, approximately two-thirds (67 

percent) were made to physicians engaged in 

solo practice (table 2). This exceeded the proportion of visits made to all physicians in solo 

practice (60 percent). Table 2 also shows that 

visits to dermatologists located in metropolitan 

areas (86 percent) exceeded the proportion to 

those practicing in nonmetropolitan areas (14 

percent). 

The data in table 3 show that the proportion 

of visits to dermatologists made by females (60 

percent) exceeded the proportion made by 

males (40 percent). This distribution by sex is 

the same for visits to all office-based physicians. 

The distribution of visits to dermatologists 

(table 3) by age of patient shows that approximately 40 percent of the visits were made by 

persons under 25 years of age. The visit rate per 

100 persons per year varied from a low of 3.6 

for persons under 15 years to a high of 13.7 for 

persons aged 15-24 years. It maybe noted from 

table 3 that the proportion of visits by black 

persons .to dermatologists (5 percent) was less 

than the proportion made by black persons to 

all physicians (8 percent). 
2


Figure 1. PATlENT RECORD 

ASSURANCE OF CONFIDENTIALITY— All i. forrnntmn Whmh would $.wm,l de.t,fi.a,c.n of an md,vid.al.


B PC. CI,C.,or an eslabl,shmenl WONbe h.ld Co. fsde.!,al Will be used only by pep.% engagml in �nd for B~?


Ihe wrPo,es .31The $u!vey and ‘..411.01 be d,s.lo,ed o, released !0 o,he, P,,,o”, or used !0, an)’ .Ihe, P“,Po$,,


1. OATEOF VISIT PATl ENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY 

Md=’7’+ 

2.	 OATEOF BIRTH 4. COLOR OR 5. PATIENT’S PRINCIPAL PROBLEM(S] 6. SERIOUSNESSOF 7. HAVE YOU EVEFlSEEN RACE COMPLAINT(S), OR SYMPTOM(S)~ VISIT PROBLEM IN ITEM 5a THIS PATIENT BEFORE? 

(In patie.t’s own words) 

I D WHITE 

++7= — 

3.	 SEX > c N E:LRAOc/K a MOST IMPORTANT 

, C FEMALE ~ @ OTHER 

> � MALE 0 UNKNOWN I b OTHER 

8.	 MAJOR IIEASON{S) FOR THIS VISIT (CJetk d/ma/or mamml . 

~~ o ACUTE PRODLEM . : WELL AD ULTJCHILD LXAM 

,, � ACUTE PROBLEM, FOLLOW. UP + ~ FAMILY PLANNING 

I c CHRONIC PROBLEM, ROUTINE ‘.- COUNSELING zADvlcE 

J : CHRONIC PROBLEM FLARE. UP :> IMMUNIZATION 

. B PRENATAL CARE ,. !: REFERHEO OY OTHER PHY?JAGENCY 

,, � POSTNATAL CARE : ADMINISTRATIVE PURPOSE 

,, D POSTOPERATIVE CARE . : OTHER {Spec, /y) 

7 

(Operative pfocedure) 

10. OIACNOSTIC/’THEFlAPEUTlCSERVICES OROEREEVPROWOEOTHIS VISIT /CheCk,//thar Wp/y/ 

01 � NONE 11 n DRUG PRESCRIBED 

02 � LIMITED HISTORY/EXAM 12 � X. RAY 

03 n GENERAL HISTORY/EXAM 13 � INJECTION 

04 n CLINICAL LAB. TEST 14 0 IMMUNIZATIONIOESENSITIZATION 

05 ~ BLOOO PRESSURE CHECK 15 ~ PHYSlOTb!ERAPY 

06 � EKG 16 � MEOICAL COUNSELING 

07 D HEARING TEST 17 � PSVCHOTHERAPViTHE RAPEUTIC 

08 � VIS1ON TEST LISTENING 

09 � ENDOSCOPY 18 G OTHER I.%+dy) 

10 D OF FICE SURGERY 

H RA.34.3 DEPARTMENT OF HEDLTH, EOUCATIOP 

REV. 8.74 PUBLIC HEALTH SE RVl( 

HEALTH RESOURCES ADMINM 

NATIONAL CENTER FOR HEALTH 

(Check one) 

, C VERY SERIOUS ~ ~ Y~s ,ONO 

J C SERIOUS	 // YES, for the problem 

indicated in / TEM 5a ? I : SLIGHTLY SERIOUS 

. r NOT. SERIOUS s � YES 20N0 I 1 

9.	 PHYSICIANS PRINCIPAL OIAGNOSIS ~ VISIT 

a DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY 

b, OTHER SIGNIFICANT CURRENT DIAGNOSES 

(In order of importance) 

11.	 DISPOSITION THIS VISIT 

(Check all [hat #pp/y) 

2 NO FOLLOW. UP PLANNEO 

: 0 RETURN AT SPECIFIEO TIME 

? C RETURN IF NEEOED, P,R.N. 

U E TELEPHONEFOLLOW. UP PLANNEO 

! C REFERRED TO OTHER 

PHYSICIAN !AGENCY 

.7 RETuRNED TO REFERRING 

PHYSICIAN 

,ND WELFARE	 O.M.E 

EXPI F AT ION 

AT(STICS 

12.	 OURATION OF 

~S VISIT (Time 

arwdlf spent wifi 

physician) 

—MINUTES 

%8. S72106 

TION DATE 12/311T5 

Data concerning the patient’s prior visit 

status (table 3) show that 74 percent of the 

visits to dermatologists were made by old returning patients and 26 percent by new patients. 

Furthermore, the percent of visits by new 

patients to dermatologists (26 percent) was proportionately higher than such visits to all physicians (15 percent). 

Table 4 presents the most common patient 

problems, complaints, or symptoms presented to 

the dermatologist. The patients’ problems, complaints, or symptoms are coded according to a 

special classification developed for use in 

NTAMCS.3 The nine problems, complaints, or 

symptoms presented in table 4 accounted for 84 

percent of all problems presented to the dermat ologist. Visits for acne (24 percent) out3Nati~n~ Center for Health Statistics: The “National 

Ambulatory Medical Care Survey: symptom classification, United States, by S. Meads and T. McLemore. 

Vital and Health Statsktics. Series 2-No. 63. DHEW Pub. 

No. (HRA) 74-1337. Health Resources Administration. 

Washington. TJ.S. Government Printing Office, May 

1974. 
admceda3 

numbered visits to the dermatologist for any 

other problem. 

Information on the physician’s judgment of 

the seriousness of the patient’s problem, complaint, or symptom (in terms of the extent of 

impairment that might result if care were not 

available) is presented in tabIe 5. Compared with 

visits to all physicians, the percent of visits to 

dermatologists for “not serious” problems was 

proportionately higher (55 percent compared 

with 49 percent), and the percent for “serious or 

very serious” was proportionately lower (12 percent compared with 19 percent). 

Tables 6 and 7 present information on the 

principal diagnosis associated with office visits 

to dermatologists. In table 6 the diagnostic data 

are grouped by the classes used in the Eighth 

Revision International Classification of Diseases, 

Adapted for Use in the United States (ICDA).4 

As might be predicted, the majority (63 percent) 

of diagnoses rendered by the dermatologist fell 

into the category of diseases of the skin and 

subcutaneous tissue. An additional 17 percent of 

the visits were for infective and parasitic diseases. Table 7 provides a listing of the 11 

specific diagnoses most commonly rendered by 

the dermatologist. These 11 diagnoses accounted 

4National Center for Health Statistics: Eighth Revision Interns tional Classification of Diseases, A dap ted 

for Use in the United States. PHS Pub. No. 1693. Public 

Health Service. Washington. U.S. Government Printing 

Office, 1967. 

Table 1.	 Number and percent distribution of office visits by 

physician specialty: United States, 1975-76 

I I 

Number of 

Physician specialty 

in &%nds J=:n 

All specialities ............... .. .... ...... 1,1 55/800 100.0 

Ganeral and family practice ............. 460,297 39.8 

Internal medicine ......................... . 130,367 11.3 

Pediatrics .... ................ ..................... 107f185 9.3 

Obstetrics and gynecology .......... ..... 97,070 8.4 

General surgery......, ................. .... .. .. 77,259 6.7 

Orthopedic surgery .... ...... ...... ...... .... 47,152 4.1 

Derrrsatalogy................. ........ ...... .. .. 35,721 3.1 

All other .......... .. ...... .... .................... 200,849 17.4 

for approximately 72 percent of all diagnoses 

rendered by the dermatologist. 

Information in table 8 shows that the most 

frequent diagnostic service ordered or provided 

by the dermatologist was the limited examination (48 percent). This percentage did not differ 

statistically from the corresponding statistic for 

all physicians (52 percent). The two therapeutic 

services most frequently ordered or provided by 

the dermatologist were drugs prescribed (55 percent) and office surgery (31 percent). The percentages for these two services were both higher 

than the overall percentages for all physicians 

(44 and 7 percent, respectively). ~ 

Data on disposition (table 8) show that less 

than 1 in 10 (9 percent) of the visits required no 

followup and that approximately two-thirds of 

the visits were scheduled for followup. 

Duration of the visit represents the amount 

of time spent by the patient in face-to-face contact with the physician. J?rom table 8 it may be 

noted that over one-hzdf (58 percent) of the 

visits to dermatologists took less than 11 minutes. The mean duration of visits for office visits 

to dermatologists was approximately 12 minutes. This was significantly less than the estimated mean duration of 15 minutes for al 

physicians. 

Table 2. Nurrber and percent distribution of office visits to 

dermatologists and percent distribution of office visits to all 

specialists by type and location of physician’s practice: 

United States, 1975-76 

Type and location of Visits to Visits to all 

physician’s practice dermatologists specialists 

Number Percent distribution 

in thousands 

All visits ....... ........ 35,721 100.0 100.0 

I 

solo ................ ....... .. 23,902 66.9 60.0 

Partner ... . ... . .... . .. . .. . . . 3,189 8.9 17.1 

Group .... ... . .. .. . .. .. .. . . 8,630 24.2 22.9 

Location of practice 

Type of practice 

I 

Metropolitan ... ......... 30,588 

Nonmetropolitan ..... 5,133 !!V!! 
4


Table 3. Number, percent distribution, and rate per year of office visits to dermatologists and percent distribution of office visits to all 

soecialtiats bv. oetient’s . age, sex, race, and prior visit status: Unitad States, 1975-76 

Visits to all 

Visits to dermatologists specialists 

Patient characteristic 

Number per Number Percent 100persons Percent 

in thousands distribution distribution per year 

All visits .............................. ........ ............ ........ 35,721 100.0 8.6 100.0 

Age

— 

Under 15 years ............................. ......................... 3,762 10.6 3.6 18.1 

15-24 years ............ ....................... ............. ............ 10,583 29.6 13.7 15,1 

2544 years .. .......................................................... 8,954 25.1 8.5 25.5 

45-64 years ............................................................ 7,881 22.1 9.2 25.1 

85 years and over ........ .............. ............................ 4,511 12.6 10.6 16.2 

sex 

. 

Female ............................... ............................ ....... 21,369 58.6 9.9 60.4 

Male .. .............. ............................ .................... ...... 14,352 40.2 7.1 38.6 

Race 

W bite .. .... .. ... . .. .. .. .... .. .. .. .. .. .... . . .... .. .. .. .. . ... ... . ...... .. ... 33,576 84.0 9.3 89.9 

Black ..... .. .. .. .. .... . . .. .. .. .. .. .. . . .... .. .... .. .. .. .... .... .. .... .. .. .. 

Other . .... .. .. .. . ... ... ... .... .. .... .. .. .. .. .. .. .. ... . .. .. .... . .. ... .. .... 

1,813 

�332 

5.1 

0.9 I 3.9 7.8 

2.3 

Prior visit status 

New patient .. .. .. .. .. . . .. .. .. . ... .. .. .. .. .. .. .... . ... .. .... .. .. .... . . . 9,228 25.8 14.6 

Old patient: 

New problem ..... .............. ...... ............................ 4,214 11.8 23.2 

Old problem ....... ...... ......................................... 22,279 62.4 62.3 

Table 4. Nutier, percent, and cumulative percent of office visits to dermatologists by the 9 most common patient problems, complaints, 

or symptoms: United States, 1975-76 

1 

9 most common patient Number of Percent Cumulative 

Rank problems, complaints, or symptoms visits in of percent of 

and NAMCS codesl thousands visits 2 visits 

I 

1 Acne .. .. .. ..... . .. .. .. .. .. .. ...<.. .. .. .. .. .. .. ... ... .. ... . .. ....loo 8,431 23.6 23.6 

2 Allergic skin reactions .. ..... .. .. ... .. . ... . . ..... .. .. ...ll2 5,712 16.0 39,6 

3 Other specific symptoms referable 

to skin .. .. .. .. .. .... .. .. .... .. .... .. .. .. ... . .... . . .... .. .. ..l2o 3,930 11.0 50.6 

4 Swelling or mass of skin .. .... .. .... .. .. .... . ... .. ... ..ll5 3,497 9.8 60.4 

5 Watts . .... .. .. .. .. .. .. .... .. .. .. .. .. .. .... .. .... .. .. .. .. .. ... .. . . 111 3,002 8.4 68.8 

6 Skin irritations not elsewhere classified., .. .. ..l 13 2,118 5.9 74.7 

7 Discoloration or pigmentation .... . ... .. .. .. ... . ...1 04 1,871 5.2 79.9 

8 Skin moles .. . .... . . .. ... . .. .... .. .. .... . . .... ... ..... . . .... ..IO9 818 2.3 82.2 

9 Surgical aftercare .. .. .. .. .. .. .. .. .. .. .. . ... .. . ... .. .......986 640 1.8 84.0 

1 Symptom titles and code numbers are based on a symptom classification developed for use in NAMCS. 

2Based on an estimated 35,721 ,OIXI *its. 
5


Table 5. Number and percent distribution of office visits to 

dermatologists and percent distribution of office visits to all 

specialists by degree of seriousness of patient’s problem: 

Unitad States, 1975-76


Visits to all 

Degree of seriousness I Visits to dermatologists specialists 

Number 

in thousands Percent distribution 

All visits...... ........ .... 35,721 100.0 I 100.0 

I 

Serious or very serious 4,152 11.6 19.2 

Slightly serious .........1. 11,869 33.2 32.3 

Not serious ............. .... . 19,701 55.2 46.5 

NOTE: Numbers may not add to totals due to rounding. 

Table 6. Nutier and percent distribution of offiie visits to


dermatologists by major ICDA diagnostic groups: Unitad


States, 1975-76


, 

Number Percent 

Major ICDA diagnostic group of visits of 

and ICDA codel in thousands visits 

All visits.......................................... 

l== 

Infective and parasitic 

diseases................................000-136


Neoplasms .............................140-239


Diseasesof the respiratory


system .................................460-519


Diseasesof the skin and subcutaneous


............................760-796


~ 

35,721 100.0 

5,888 16.5 

3,743 10.5 

�553 1.6 

lD@noati~ ~oUP5 and codes are based on E&hth Re*n 

Intermtfonal Cks@?ntion of Di.wase% Adapted for L%e in the 

United States 

Table 7. Nunber, percent, and cumulative percent of office visits to dermatologists by 11 most common principal diagnoses: 

Unitad States, 197S76 

1


2


3


4


5


6


7


8


9


10


11


Diseasesof sebaceous glands ......................706


Other eczema and dermatitis ......................692


Other viral diseases.....................................079


Other hypertrophic and atrophic


conditions of skin ..................................701


Other malignant neoplasm .........................I 73


Psoriasisand similar disorders ....................696


Benign neoplasm of skin ............................21 6


Pruitus and related conditions ....................698


Dermatophytosis ........................................110


Saborrheic dermatitis .................................69O


Other diseasesof skin.................................7O9


Number 

of visits 

in thousands 

9,598 

3,701 

3,088 

1,965 

1,737 

1,372 

1,188 

8m


782


743


727


Percent Cumulative 

of percent of 

visits2 visits 

26.9 

10.4 

8,7 

5.5 

4.9 

3.8 

3.4 

2.3 

2.2 

2.1 

2.0 

26.9 

37.3 

46.0 

51.5 

56.4 

%; 

65.9 

66.1 

70.2 

72.2 

1Diagnostic ~tegories and codes are based on E@hth Revision Interrsati.onal C!krssification Of LMWZES, Adapted for U* in the 

Uni ed States. 

i Based on an estimated 35,721,000 visits. 
6


Table 8. Nutier and percent of office visits to dermatologists and percent of office visits to all specialists by services ordered or 

provided, and disposition and duration of visit: United States, 1975-76 

Service ordered or provided and Visits to all

Visits to dermatologists 1 disposition and duration of visit specialists

Number in 

Service ordered or provided thousands Percent of visits 

No wrvice ................ ............................................ .. 

Diagnostic service (selected services): 

Limited history and/or examination .................. 

General history and/or examination ...... ............ 

Clinical laboratory test ................... ................... 

xmy ................................................................. Blood pressure check.., ...... ................................ 

Therapeutic service (selected services): 

Drug prescribed .................. ......... ............ .. ........ 

injection ........................................... .. ............... 

Immunization and/or desensitization ................ 

Office surgery ....................... ............................. 

Physiotherapy ....................... ................ ............ 

Medical counseling ....................... ..................... 

Disposition of visit (selected actions) 

No followup ......... ....... .... ............... ....................... 

Return at a specified time ..................... ................ 

Return if needed ............................. .... .................. 

Telephone followup ...... ........ ................ .. ...... ........ 

Referred to other physician, agency ...... .. ........ ...... 

Duration of visit 

O minutesl ........... ............ ..................................... 

1-5 minutes ....... .................................................m.. 

6-10 minutes .................................... .......... ........... 

11-15 minutes .. ......................................... ............ 

16-30 minutes ....................................................... 

31 minutes or more ..... ....................... ................... 

1,234 3.5 2,5 

17,108 47.9 51.6 

1,493 4.2 16,3 

1,755 4.9 22,8 

�336 0.9 7.5 

�377 1.1 33.2 

19,625 54.9 43.6 

2,085 5.9 13,1 

892 2.5 4.9 

11,128 31.2 6,9 

2,321 6.5 2,6 

4,874 13.6 13.0 

3,359 9.4 12.3 

23,812 66.7 60.2 

7,397 20.7 21.9 

838 2.4 3.5 

%346 1.0 2.8 

1,058 3.0 1.8 

6,160 17.3 15.1 

14,481 40.5 31.5 , 

9,S76 27.7 26.6 

3,899 10.9 19.5 

� 248 0.7 5.5 

1 ~epresent~ no face.to.face contact betweenthe patientand the ph@cian. 

SYMBOLS 

Data not available .———. . . -

Category not applicable —-—— . . . 

Quantity zero .—— —-

Quantity more.than Obut less than 0.05-–- 0.0 

Figure does not meet standards of * reliability or precision —— 
.................................................

........... .................................... ...................................................

.. ...................

...............................................

...................................................

....... ................................... ....... ....................... .........

....................

.. ....

..............

.................

............

...........

TECHNICAL NOTES mate. Relative standard errors of selected aggregate statistics are shown in table I. The stan&u-d 

SOURCE OF DATA: The information presented errors appropriate for estimated percentages of 

in this report is based on data collected in the visits are shown in tabIe II. 

Nat i onal Ambulatory Medical Care Survey 

(NAM(X) during 1975 and 1976. The target T*le L Approximate relative standard errors of estimated 

population of NAMCS encompasses office visits nusriwrs of offiie visits, ‘NAMCS, 1975-76 

within the conterminous United States made b y , 

ambulatory patients to non-FederaI physicians 

who are principally engaged in office practice 

and not in the specialties of anesthesiology, pathology or radiology. The National Opinion Research Cent er, under contract to the NationaI 

Center for Health Statistics, was the organization 

responsible for the survey’s field operations and 

data processing. 

SAMPLE DESIGN: NAMCS utilizes a multistage 

probability design that involves sampIes of primary sampling units (PSU’S), physician practices 

within PSU’S, and patient visits within practices. 

Each year a sample of practicing physicians is selected from masterfiles maintained by the American Medical Association and American Osteopathic Association. The 1975 and 1976 NAMCS 

samples included 110 dermatologists, of whom 8 

were found not eligible for participation at the 

time of the survey. Of the 102 dermatologists 

who were eligible for participation in NAMCS, 

81 (79.4 percent) participated in the survey. The 

sample physicians are requested to complete Patient Records5 (brief encounter forms) for a systematic random sample of office visits taking 

place within their practice during a randomly assigned weekly reporting period. The number of 

Patient Records completed by sample dermatologists was 2J565 for the 2-year period. 

Characteristics of the physician’s practice 

such as primary specialty and type of practice 

are obtained during an induction interview. 

SAMPLING ERRORS: Since the estimates for 

this report are based on a sample rather than the 

entire universe, they are subject to sampling variabilityy. The standard error is primarily a measure 

of sampling variability. The relative standard 

error of an estimate is obtained by dividing the 

standard error of the estimate by the estimate 

itself and is expressed as a percent of the esti5See figure 1. 

Estimated numke; Relative standard 

of office visits error in 

in thousands percent 

6rM. . .. . . . . 30.2


1.000 . . . . .. . 23.5


2;mo . . . . 16.7


4.000 ....”....................”.. . . . .
 12.0


Io$mo. .. . . 8.0


40,000 . . 4.8


200,000 . .. . . . . . 3.4


lflmgm ..." . .. . 3.1


l?xarnple of use of table: An aggregate estimate of 25,000,000 

viaiis has a relative standard error of 6.4 percent or a standard 

error of 1,600,000 visits (6.4 percent of 25,000,000). 

Table II. Appmxirrsate standard errors of ~rcentaqes of estimated 

numbers of office visits, NAMCS, 19%-76 

Estimated percentage Baseof percentage 

(numb.w of visits 1 or 5 or 10or 20 or 30 or ~~ in thousands) 99 95 90 80 70 

Standard error in percentage points 

4#mo........... 

......................” 3.0 6,5 9.0 12.0 13.8 15,0 

l$NXL ....... ............ 2.3 5.1 7.0 9.3 10.7 11.6 

2,000 . 1.6 3.6 4.9 6.6 7.5 8.2 

. . 1.2 2.5 3.5 4.7 5.3 5.8


10$MCL .
 . . . 0.7 1.6 2.2 2.9 3.4 3,7


40,00CS .
 . 0.4 0.8 1.1 1.5 1.7 1.8


200,000 .
 . ... 0.2 0.4 0.5 0.7 0.8 0.8


1,000,000 .
 . . L
 0.1 0.2 0.2 0.3 0.3 0.4


Eawrrpfe of use of tab&: An estimate of 20 percent baaed.on 

anaggragate estimate of 80,000,000 visits has a standard error of 

1.3 percent. The reIative standard error of 20 percent is 6.5 percent (1.3 percent + 20 percent). 

DEFINITIONS: An ambulatoy patient is an individual presenting himself or herself for personal health services who is neither bedridden 

nor currently admitted to any health care institution on the premises. 

An office is a pIace that the physician identifies as a location for his or her ambulatory 

practice. Responsibility y over time for patient 

care and professional services rendered there 

generalIy resides with the individual physician 

rather than an institution. 
8


A visit is a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working under the ph ysician’s supervision for the purpose of seeking care and rendering health services. 

A physician is a duly licensed doctor of 

medicine (M.D.) or doctor of osteopathy (D. O.) 

currently in office-based practice who spends 

time in caring for ambulatory patients. Excluded 

from NAMCS are physicians who are hospital 

based; physicians who specialize in anesthesiology, pathology, or radiology; physicians who 

are federally employed; physicians who treat 

only institutionalized patients; physicians employed full time by an institution; and ph ysicians who spend no time seeing ambulatory 

patients. 
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH Statistics 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health service ] Number 38 � August 25,1978 

OFFICE VISITS TO PSYCHIATRISTS: NATIONAL 

AMBULATORY MEDICAL CARE SURVEY, 

UNITED STATES, 1975-76’ 

During combined calendar years 1975 and 

1976 psychiatrists’ offices were the settings for 

30.6 million ambulatory care visits by patients 

who presented a broad spectrum of emotional, 

ideational, and behavioral problems. 

The data were obtained during the National 

Ambulatory Medical Care Survey (NAMCS), a 

s~ple survey conducted by “the Division of 

Health Resources Utilization Statistics of the 

National Center for Health Statistics. The estimates in this report are based on information 

recorded by participating psychiatrists on brief 

encounter forms (see Technical Notes) during 

sampled office encounters. A brief description 

of the sample design and an explanation of the 

sampling errors associated with selected aggregate statistics can be found in the TechnicaI 

Notes of this report. 

Most visits to psychiatrists were to offices 

located in metropolitan areas (94 percent); this 

was a higher proportion than that for all specia.lkts (figure 1)0 

The proportion of visits to psychiatrists engaged in SO1Opractice (78 percent) exceeded 

those to other types of arrangements. In this 

respect office based psychiatric practice also 

differed from the average of 60 percent for all 

specialists. 

Reflecting the continuous nature of psychiatric care, 9 of 10 visits were made by patients 

the physician had seen before and who returned 

for care of a problem the physician had treated 

1This report wzs prepared by Beulah K. CYPress~ 

Ph. D., Division of HeaIth Resources Utilization Statistics. 

Figure 1. PERCENT DISTRIBUTIONS OF OFFICE VISITS TO 

PSYCHIATRISTS ANO TO ALL SPECIALISTS BY LOCATION 

ANO TYPE OF PRACTICE UNITEO STATES, 1975-76 

WTE W pychiitristf 

VWts t. alI splcidii } 

S2.8 

Wtw-alitan mea 73,3 

6.2 Nmmampdiun SCM r26.7 

S010 practice 

I--pmuimk 

t 1 1 I I 1 ! t 1 1 

0 20 40 Ml BO 100 

PERCENT OF VISITS 

previously (figure 2). The ratio of return visits to 

new problem visits was higher for psychiatrists 

than for any other specialty. New problem visits 

included initial visits and those made by patients 

known to the physician but presenting a ,new 

problem. For each new problem visit to a 

psychiatrist there were 8.6 “old” problem visits 

in contrast to an old to. new ratio of 1.6 for all 

specialkts. 

Of the 2.1 million new patients seen by 

psychiatrists, 30 percent were referred by another physician or agency. 

Distributions of visits by patient age, sex, 

and race are shown in table 1. The majority of 

visits included patients between the ages of 25 

and 44 years. The visit rate was also higher for 

this age range than for any other group. Patients 

65 years and over comprised the smallest group 

visiting. For each 100 persons of that age in the 
2 advancedata 

Figure 2. PERCENT DISTRIBUTIONS OF OFFICE VISITS TO population only two visits were made to psychiPSYCHIATRISTS AND TO ALL SPECIALISTS BY VISIT atrists’ offices, whereas there were about 15 

STATUS: UNITED STATES, 1976-76 visits for each 100 persons aged 25-44 years, 

103 Females visited at a significantly higher rate than 

did males. Members of the white race clearly 

90 outnumbered other persons in visits with the I visit rate for the former group about three 

times the rate of the latter group. The distribution of mental disorders among different 

races, or the total pattern of psychiatric care by 

race, should not be inferred from these data. 

First, disease incidence and prevalence cannot be 

equated with Visiis for a disease; and second, 

care may be obtained from facilities other than 

- New Pat!em physicians’ offices. For example, in 1975 members of black and all other races utilized outso 

Returning patient: 

~ tie. problem 

~ Old problem 

pat ient departments of hospitals and freestanding psychiatric clinics, settings not 

presently included in NANICS, at a higher rate 

20 than did white persons.2 

Seriousness of the patient’s problem was 

10 [ evaluated by the psychiatrist using the criterion 

of the extent of impairment that might result if — o	 L no care were available. On a four-point scale 

Psychiatrists All !+ecialists ranging from not serious to very serious, psychiatrists judged 65 percent of their visiting patients to be serious or very serious. Only 11 perTable 1. Number, percent distribution, and rate of office visits to cent were considered not serious in contrast to 

psychiatrists “bv patient age, sex; and race: United States, the finding of about 49 Percent

. for all specialists 

1975-76	 (fisrure 

,“ 

3).=

46-54 

Number c Visit Patients’ problems were more often diagAge, sex, and race visits in Percent rate per nosed in the nonpsychotic group of mental disthousand Iistributiol 100 in 

~opulation orders (79,5 percent) then in the psychotic 

(20.5 percent). Despite a broad array of symp- All visits ... .. .. .. .... .. .. .... .. .. . 30,616 100.0 7.3 toms and complaints presented by visiting patients, 84 percent of the visits were diagnosed by 

Age psychiatrists in only seven diagnostic classes 

Under 15 years .. .. .. .. .. .. ... . .. . 2,632 8.6 2.5 (table 2). Primary diagnoses listed on the Patient 

15-24 years .... ... .. .. . ... .. .... . ... 4,662 15.2 6.0 Record by participating physicians were clas25-34 years ...... .. . ... . .. .. ..... . .. 

3544 years .... .. .. .. ... ... .. .... .. . 

9,109 

7,053 

29.8 

23.0 

15.0 

15.8 

sified according to the Eighth Revision Interyears ........ ................. 4,284 14.0 9.2 national Classification of Diseases, A dap ted for 

55-84 years ....... .................. 1$34 6.3 4.9 Use in the United States (lCDA).3 Another 

65 years and over ................ 933 3.0 2.2 

— 

Sex 2 Division of Biome@ ~d Epidemiology, h’ationaI 

Institute of Mental Health. Unpublished data from the 

Female .. .... .. . ... .. . ... .. .... .. .. .... 18,406 60.1 8.5 National Reporting Program of the National Institute of 

Male . .. .. .. .... .. .. .. .. .. .. ..... . .. .... . 12,210 39.9 6.1 Mental Health. 

Race 

3NationaJ Center for Health Statistics: l?ighth Revision International Classz~ica tion of Diseases, Adapted 

White .. .. ... .... . .. .. .. .. .. .... .. .. .... 

Black and other races...,., . ... 

29,319 

1,297 

95.8 

4,2 

8.1 

2.4 

for Use in the United States. PHS Pub. No. 1693. Public 

Health Service. Washington. U.S. Government Printing 

Office, 1967. ., 
1

2

3

4

5

6

7

dmcedaa3 

Figure3. PERCENT DISTRIBUTIONS OF OFFICE VISITS TO 

PSYCHIATRISTS AND TO ALL SPECIALISTS BY DEGREE 

OF SERIOUSNESS OF THE PATIENT’S PROBLEM:UNITED 

STATES, 197576 

1oo-


eo80 -

70 -

k 60 -
 ~


>


L 

; 50 -

z 

H 

z 

#! ’lo 

Not serious 

30 -

ET 

20 - serious or very 

10-

— “o— 

P5ychiatri5rs All specialkts 

taxonomy of mental disorders, the Diagnostic 

and Statistical Manual of Mental Dh-orders, 

Second Edition (DSM-11), which is also used by 

the mental health community, is compatible 

with ICDA at the three-digit level of specificity, 

which is used in this report.4 DSM-H includes a 

4Amencan Psychiatric Association Committee on 

Nomenclature and Statktics: D@nostic and Statktical 

Manual of Mental D&orders, 2d ed. American Psychlatzic 

Association. ~ashington, D.C. 1968. 

Table 2. Number, percent, and cumulative pereant of office visits to 

glossary of operational def+itions of terms 

which the nonmedical reader may find useful. 

A diagnosis of neurosis was clearly the foremost clinical determination made by psychi- ‘ 

atnsts, accounting for 42-percent of all visits. 

Personality disorders (about 14 percent) increased the total to more than half of aI1visits. 

Two psychotic states, schizophrenia (11 percent) and affective psychosis (about 5 percent) 

were among the highest ranking illnesses. 

The group of visits which were coded in the 

symptoms and ill-defined condh.ions ICDA class 

of senility and ill-defined diseases (790-796) 

were chiefly listed as depression (790.2). Apparently the physician indicated that these visits 

were not of psychotic or psychoneurotic origin, 

which are usuaIIy assigned to mental disorders 

(290-315). 

An examination of the characteristics of 

psychiatric office practice is largely a study of 

treatment of mental disorders in the setting of 

ambulatory office care. While not all patients 

with mental problems visited psychiatrists’ offices in preference to other physicians, almost all 

visits to psychiatrists involved mental ailments, as 

previously shown. Of the 48.5 million visits to 

all specialists for mental disorders during 

1975-76, 54 percent, or 26.2 million, were to 

office based psychiatrists. As illustrated in figure 

4, visits to other specialists were mainly diagnosed as neuroses. Psychiatrists had the major 

portions of visits for the psychotic problems 

schizophrenia (92 percent) and affective 

psychoses (73 percent). Wits by patients requiring guidance for transient and situational disturbances also occurred more frequently in 

psychiatrists by 7 most common principal diagnoses classified by 

ICDA code in rank rder of number of visits: lit&j States, 1975-76 -

Number of 

Rank Principal diagnos-s visits in Percent of visits Cumulative 

and ICDA code4 

thousands pereent 

Neuroses ....................................................300 12,824 41.9 41.9 

Personality disorders ..................................3Ol 4,117 13.5 55.4 

Schizophrenia ............................................295 3,445 11.3 86.7 

Transient and situational disturbances..,....3O7 2,188 7.2 73.9 

Affective psychoses....................................298 1,404 4.6 78.5 

Nervousness and debility (depression) ........79O 1,115 3.6 82.1 

Medkal or special examination ..................YOO 570 1.9 84.0 

lDiagnostic groupings and codes are based on the Eighth Revision Intematioml Ckws@atfon of DLwase~ Adapted for Use in the 

United S’s17tes. 
4 actvancedata 

Figure 4. PERCENT DISTRIBUTION OF OFFICE VISITS FOR 

MENTAL DISORDERS BY MOST VISITED SPECIALTY: 

UNITED STATES, 1975-76 

psychiatrists’ offices than in those of other specialists (table 3). 

The Patient Record used in NAMCS was 

developed as a general purpose data collection 

instrument for the purpose of capturing the 

most pertinent information about ambulatory 

office care visits. The practice of psychiatry, 

unique in its diagnostic and therapeutic procedures; cannot be as succinctly characterized by 

the NAMCS data as can some other specialties. 

The types of diagnostic procedures described on 

the Patient Record were not heavily utilized 

during visits to psychiatrists as table 4 shews. 

Only from about 3 to 9 percent of visits included the usual medical procedures. However, 

Table 3. Nutier of office visits to all specialists and percent of 

office visits to psychiatrists, by selected diagnoses classified 

by ICDA codes: United States, 1975-76 

, 

Number of 

Diagnosis and ICDA codel visits to all Percent 

to

of 

visits specialists in 

thousands psychiatrists 

Schizophrenia ..... .. .. ... . ... ... .. .. .. .. .295 3,764 91.5 

Affective psychoses .... . .. ... . .. .. .. ...296 1$23 7’3.0 

Neuroses ..... .... .. .. .. .... ... .... . .. .... ...300 25,698 49,9 

Transient and situational 

disturbances ...... ..... . .. .. .. . . ..... . 307 2,913 75.1 

Nervousness and debility 

(depression) ........ .. .... .. ...... .....790 6,132 18.2 

lDtignostic groups and codes are based on the %~~b Reviar”onInternational Classification of Diseases, Adapted for Use 

in the United States. 

Table 4. Number and percent of office visits to psychiatrists, by 

selected diagnostic and therapeutic services ordered or provided: Unit&l States, 1975-76 

Diagnostic or 

therapeutic service 

Limited history and 

examination ................. ............ .... 

General examination ........ ...... .......... 

Clinical lab test .... ............................ 

Blood pressure check .. ............ ......... 

Drug prescribed ............ .... .. .... ...... .. .. 

Injection or immunization ...... ......... 

Counseling ............. ...... .......... .......... 

Psychotherapy ...... .... .. ...... .. .... ........ . 

Number of 

visits in Percent of 

thousands visits 

2,745 9.0 

1,263 4.1 

751 2,5 

1,639 5.4 

7,732 2!5,3 

814 2.7 

1 #597 5.2 

26,337 86.0 

since NTAMCS did not provide separately for 

diagnostic procedures more commo; to psychiatry such electroencephalograph and psychological testing, there is no way to estimate the 

scope of diagnostic activity. Many of these techniques are embedded in the single hTAMCS category, “psychotherapy,” Unable to select a more 

specific category, psychiatrists checked this term 

for 86 percent of their visits. The definition of 

“psychotherapy” as used in hTAMCS, shown in 

the Technical Notes, covers a wide variety of 

techniques, some diagnostic and some therapeutic. Therefore it is not possible, to determine 

whether the 86 percent includes diagnostic, 

therapeutic, or other types of services. 

As with diagnostic services, data regarding 

certain therapeutic techniques such as psychoanalysis, sociological services, hypnotherapy j 

group therapy, or shock therapy were not available through NAMCS. Drugs were administered 

or prescribed for about 25 percent of visits 

which was less than the average proportion of 44 

percent of visits to all specialists. Drug therapy 

was selected more often for the psychotic diagnoses, schizophrenia and affective psychoses, 

than for the nonpsychotic diagnoses, personality 

disorders and neuroses. 

Highly correlating with the proportion of 

return visits, 89 percent of psychiatrists’ visits 

resulted in the instruction to return at a specified time. In only 4 percent of visits was no 

followup planned. The disposition of very few 

visits was admittance to a hospital. 

In view of the importance of direct physician-patient communication during psychiatric 

visits, it is not unexpected that the average dura-
dmcdata5 

Table 5. Nuder and percent distribution of office visits to 

psychiatrists by duration of visit: United Stetes, 1975-76 

Number of 

Duration of visit visits in Percent 

thousands distribution 

All visits..., ... ................ .... ............ 30,616 100.0 

0-5 minutes ....... ............................... 759 2,5 

6-10 minutes, ................................... 892 2.9 

11-15 minutes ............ ...................... 1,197 3.8 

1630 minutes ............ ...... ................ 5,434 17,8 

31$0 minutes ...... ............ ................ 21,181 69.2 

61 minutes or more .......................... 1,153 3.8 

TECHNICAL 

SOURCE OF DATA: The information presented 

in this report is based on data coIlected in the 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS) during 1975 and 1976. The target 

population of NAMCS encompasses office visits 

within the conterminous United States made by 

ambulaory patients to physicians who are principallyengaged in office practice. The NationaI 

Opinion Research Center, under contract to 

NCHS, was the organization responsible for the 

survey’s fieId operation. 

SAMPLE DESIGNi NAMCS utilized a multistage probability design that involves samples of 

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within 

practices. Each year a sampIe of practicing 

physicians is selected from master files maintained by the American Medical Association and 

the American Osteopathic Association. The 

1975-76 sample included 468 psychiatrists with 

a response rate of 88 percent for the 2 years. 

These physicians are requested to complete 

Patient Records5 for a systematic random sample of office visits taking place within their practice during a randomly ,assigned weekly reporting period. Participating psychiatrists completed 

7,462 Patient Records during the 2 year period. 

Characteristics of the physician’s practice, such 

as primary speciah.y and type of practice, are 

obtained during an induction interview. A de5See figureI. 

tion of psychiatric encounters exceeded that of 

other physicians. The mean contact duration 

was 15.3 minutes (*0.2) for all physician visits 

and 46.9 minutes (*1.85) for psychiatrists’ 

visits. According to the data listed in tabIe 5 

over 69 percent of visits to psychiatrists lasted 

from 31 to 60 minutes. Only 4 percent were 

more than 60 minutes long, and 9 percent consumed less than 16 minutes. 

NOTES 

tailed description of the NAMCS design and


procedures may be found in Series 13, Number


33, of Vital and Health Statistics.


SAMPLING ERRORS: Since the estimates for


this report are based on a sample rather than the


entire universe, they are subject to sampling vari­


ability
. The relative standard error of an estimate is primarily a measure of sampling variability. The relative standard error of an estimate 

is obtained by dividing the standard error of the 

estimate by the estimate itself and is expressed 

as a percent of the estimate. Relative standard 

errors of selected aggregate statistics are shown 

in table I. The standard errors appropriate for 

the estimated percentages of office visits are 

shown in tabIe II. 

Table 1. Approximate relative standard error of estimated 

numbers of office visits, NAMCS 1975-76 

Estimate Relative standard 

in error in 

thousands percentage points 

600 ........................................................ 30.2 

1,000 ..................................................... 23.5 

2.mo ..................................................... 16,7 

4,000 ..................................................... 12,0 

10,000 ................................................... 8.0 

40,000 . ................................................. 4.8 

200,000 ................................................. 3.4 

1,000,000 .............................................. 3.1 

Example of use of table: An aggregate ,estimate of 25,000,000 

visits hasa relative standard error of 6.4 percent or a standard 

error of 1,600,000 vtilts (6.4 percent of 25,000,000). 
6 

Tabla Il. Approxi! me standard errors of percentages for ROUNDING: Aggregate estimates of office 

estimated nun ~ersof office visits, NAMCS 1975-76 visits presented in the tables are rounded to the 

Estimated parentage nearest thousand. The rates and percents, howBase of percentage ever, were claculated on the basis of original, un­ (number of visits 1 or 5 or lOor 20

80

or 30 or so rounded figures. Due to rounding of percents, the in thousands) 99 95 90 7(3 

I I I I I sum of percentages may not equal 100.0 percent. 

Standard error in percentage points DEFINITIONS: An ambulatoy patient is an in200,000 ................. 0.2 0.4 0.5 0.7 0.8 0.8 tifies as a location for his ambulatory patients. 1,000,000 .............. 0.1 0.2 

........................ 3,0 6.5 9.0 12.0 13.8 15,0 dividual presenting himself for personal health 

1,000............. ....... 2.3 5.1 7.0 9.3 10.7 11.6 services who is neither bedridden nor currentlv 

2,000 ......... ............ 

4,000 .................. .. . 

10,000 .......... ........ . 

1.6 

1.2 

0,7 

3.6 

2.5 

1,6 

4.9 

3.5 

2.2 

6.6 

4.7 

2.9 

7.5 

5.3 

3.4 

8,2 

5.8 

3.7 

admitted to any health care institution on th~ 

premises. 

40,000 .................. . L0.4 0.8 1.1 1.5 1.7 1.8 An office is a place that the physician iden0.2 0.3 0.3 0.4 Responsibility over time for patient care and 

Exampk of use of table: An estimate of 20 percent based on professional “services rendered- there generally an aggregateestimate of 80,000,000 visits has a standard error or 

1.3 percent. The relative standard error of 20 percent is 6.5 (1.3 resides with the individual physician rather than 

percent + 20 percent). an institution. 

Figure 1. PATlENT RECORD 

ASSURANCE OF CONFIDENTIALITY— A!( ,nl.,rr,awm .uh,ch vm.ld w,rn,! ,d.nl,i,cw.n .1 an ,ndtvd.al, 

a pract!ce, m an .Slnblmhmml will b. held CO.fden!, al, w,ll be used only by persons engaged in a.d la B~? 

!he IWPOSW of the S.W$ and wI) ..1 be d,$d.md m mle.%ed 10 .Ihcv Pw$.n$ w .ti !W any ah., p.wmse. 

I . DATE OF VISIT PATl ENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY MZz-7%7+ ,, 

2. IIAT[ OF BIRTH 4. COLOR OFI 5. PATIENT’S PRINCIPAL PROaLEM(S) 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN 

RACE COMPLAINT(S), OR SYMPTOMISl ~ VISIT PROaLEM IN ITEM 58 THIS PATIENT BEFORE 7 

(/. pa flenl’s own wofd$) (Check one) 

, G WHITE Day Yr I G VERY SERIOUS 

~QYf3 zONO 

3.	 SEX I Z NEGRO{ a MOST 

aLACK IMPORTANT J G SERIOUS II YES. for the problem 

indicated in ITEM 5a 7 

A ~ FEMALE , 0 OTHER I C SLIGHTLY SERIOUS 

I m MALE ‘ ~ UNKNOWN b, OTHER . C NOT SERIOUS , � YES >ENO 

8. MAJOR REASONISJ FOR THIS VISIT(Cieckallw,, rearms] 9. PHYSICIAN’S PRINCIPAL OIAGNOSIS ~ VISIT — 

a, DIAGNOSIS ASSOCIATE WITH ITEM 5a ENTRY 

~ ACUTE PROBLEM “ z WELL AOULT,CHILD EXAM 

.: D ACUTE PROe LEM, FOLLOW. UP . : FAMILY PLANNING 

, Q CHRONIC PROBLEM, ROUTINE E CO UN SE LING!ACVICE 

.. Q CHRONIC PROBLEM, FLARE. UP :1 IMMuNIZATION 

, Q PRENATAL CARE . . :, REFERRED BY DTHER PHYS/AGENCY b. OTHER SIGNIFICANT CURRENT OIAGNOSES 

/6 Q POSTNATAL CARE I ~ ADMINISTRATIVE PURPOSE (In order of importance) 

,, ~ POSTOPERATIVE CARE ,. ~ OTHER ISPeC,{y I 

--l I 

(Operatwe procedure) 

10. DIAGNOSTIC/THERAPEUTIC SERVICES OROEFIEO/PROVIOEO THIS VISIT fCh#ckd/rhx @y/ 1 I . DISPOSITION THIS VISIT 12. OUFIATION OF 

~ VISIT(rime 01 a NONE 11 D DRUG PRESCRIBED (Check all th,f ~) actually spent with 

I 

02 � LIMITEO HISTORVIEXAM 12 n X. RAY phys;c;an] 

03 0 GENERAL HISTORY/EXAM 13 D INJECTION , ~ NO FOLLCIW.UP PLANNEO 

04 D CLINICAL LAB. TEST M 0 lMMUN12AT10N10E5 ENsIT12AT10N 1 C RETURN AT SPECIFIED TIME 

05 m BLOOD PRESSURE CHECK 15 ~ PHYSIOTI!ERAPY’ I E RETURN IF NE F.OEO, P,R N, 

cm ~ EKG 16 D MEDICAL COUNSELING . r, TELEPHONE FOLLOW. UP PLANNED 

07 0. HEARING TEST 17 � PSYCHOTHERAPYITHE RAPEUTIC $ Q REFERREO TO OTHER —MINUTES 

PHY?JCIAN!AGENCY 08 a VISION TEST LISTENING 

09 0 ENoOSCOPV 18 E OTHER L$oullv) __ 

, z RiTURNEO TO REFERRING 

PHYSICIAN 

10 n OFFICE 5URGFRY ~, ADMIT TO HOSPITAL 

E E OTHER lSmc,f y)_ 

HRA.34. S Department OF HEALTH, EDUCATION ANO WELFARE O. M.EI. +? S8.S72106 

REV, 8.74 PUBLIC HEALTH SERVICE EXPIRATION DATE 12131f7s HEALTH RESOURCES AOMINIS7RATION 

NATIONAL CENTER FOR HEALTH STATISTICS 
---

admdata7 

A visit is a direct personal exchange between 

an ambulatory patient and a physician or a Staff 

member working under the physician’s supervision for the purpose of seeking care and 

rendering health services. 

A physician is a duly licensed doctor of 

medicine (M.D.) or doctor of osteopathy (D.O.) 

currently in practice who spends time in caring 

for ambulatory patients at an office location. 

Excluded from NAMCS are physicians who specialize in anesthesiology, pathology, radiology; 

physicians who are fedendly employed; physicians who treat only institutionalized patients; 

physicians employed fuIl time by an institution; 

and physicians who spend no time seeing ambulatory patients. 

Medical counseling: Instructions ~d recommendations regarding any health problem, including advice or counsel about diet, change of 

habit, or behavior. Physicians are instructed to 

check this category only if the medical counseling is a szgnzj%ant part of the treatment. 

Psych o th erapy/therapeutic ktening:” All 

treatments designed to produce a mental or 

emotional response through suggestion, persuasion, reeducation, reassurance, or support, inCIUdin g psychological counseling, hypnosis, 

psychoanalysis, and transactional therapy. 

SYMBOLS 

I Data not available 1 

I Categorynot a@icable- . . . I 

Quantity zero 

Quantity more.than Obut less than 0.05— 0.0 

Figure does not meet standards of 

* reliability or precision 

\ 
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT C)F HEALTH, EDUCATlON, AND WELFARE ~ Public Health Service I Number 38 � $eptember 7,1978 

Office Visits to Urologists, National Ambulatory 

Medical Care Survey: United States, 1975-761 

Using data from the National Ambulatory 

Medical Care Survey (NAMCS), this report 

describes an estimated 20,728,000 visits made to 

the offices of urologists over the 2-year span 

from January 1975 through December 1976. 

NAMCS is a sample survey designed to explore 

the provision and utilization of ambulatory care 

in the physician’s office-the setting where most 

Americans seek health care. The survey is conduct ed yearly throughout the cote~inous 

United States by the Division of Health Resources Utilization Statistics of the National 

Center for Health Statistics. The survey sample 

is selected from doctors of medicine and osteopathy who are principally engaged in officebased, patient-care practice. Excluded from the 

sample are an indeterminate number of physicians who render some office-based ambulatory 

care but whose patient-care activities are secondary to another primary role such as teaching, 

research, or administration. Also excluded from 

the NAMCS scope are physicians who are hospital based; those whose specialty is anesthesiology, pathology, or radiology; and physicians 

in Federal service. 

Since the estimates presented in this report 

are based on a sample rather than the entire universe of office-based, patient-care physicians, 

they are subject to sampling variability. Technical Notes, which follow this text, explain this 

and present guidelines for judging the relative 

precision of estimates in this publication. The 

directions offered there also provide the basis . 

1This report was prepared by Hugo Koch, Division of 

Health Resources Utilization Statistics. 

for judging the statistical significance of differences between estimates. 

DATA HIGHLIGHTS 

With their estimated 20,728,000 office visits 

in the 2-year sp& 1975-76, urologists were 

among the 13 types of specialists who figured 

most prominently in the provision of officebased ambulatory care (table 1). 

Compared with the entire universe of officebased physicians, the overall preference for solo 

practices over multiple-member was reversed for 

urologists (table 2); more than half of the visits 

(57 percent) were made to physicians in 

multiple-member arrangements, a preference 

Table 1. Number of office visits to the 13 most-visited specialists, 

by type of specialty in rank order: United States, 197S76 

Number of 

Rank Type of specialty visits in 

thousands 

1 General and family practice . .. . .. ... ... . .. .. . 460,287 

2 Internal medicine .. ... .. . . .. ... . .. . .. .... . .. . . .. .. . 130,367 

3 Pdiatrics . . .. .. ... .. ... . ..... . . ... . .. . .. . .... . . ..j . . .... 107,085 

4 Obstetrics and gynecology . . .. ... .... ... .. .. ... 97,070 

Generai surgery . ... .. .... . .. .. .. . ... . ... . ... .. .. .. .. 77,259 

: Ophthalmology .. .. . .... . .. . ... . .. .. .. .. .. .. . . .. .. .. 53,959 

7 Orthopedic surgery .. .. .. .... ... .. .. .. .. .. . .. .. .. . . 47,152 

8 Dermatology . .. .. . . .. ... . . ... .. .. .. .. . .. ... .. . .. . . ... 35,721 

9 PsychiatW .. .. .... .. . . ... . .. .. . .... . . .. .. . .. ... .... .. .. 30,616 

10 ~olaWngology . .. .. .. ... . .. .... . .. .. .. . .. ... .. . . ... 27,192 

11 urology . .... . . .. .. .. . .. ... .... . .. .. .. . .. .. .. ... . . .. .. . .. 20,728 

12 - Cardiovascular disease . . ... .. .. . .. .. . ... . . .. .. .. . 13,517 

13 Neurology . .. .. . ... .. ... . .. ... . . ... .. . .. .. ... .. . .. . .. .. 3,784 
2 

Table 2. Nurrber and percent distribution of office visits to 

urologists and percent distribution of office visits to all 

specialists by location and type of practice: United States, 

1975-76 

Location and type 

of practice 

All visits ........... 

Location of oractice 

Metropolitan aree2 ........... 

Nonmetropolitan area ...... 

Type of practice 

solo ................................. 

Other ............................... 

Visits to– Number of ~- visits to All urologists Urologists 

in thousands specialists 

Percent distribution 

20,728 100.0 1100.0 

16,871 81.4 73.3 

3,857 18.6 26.7 

8,867 42.9 60.0 

11,841 57.1 40.0 

l~~ed on an estimated 1.155.900.000 ViSits made to al] 

office-based physicians in 1975 and 19“16. 

2Within a standard metropolitan statistical area (SMSA). 

Composition of SMSA’S does not reflect 1974 adjustments. 

shared by four others among the most-visited 

specialists: pediatricians, obstetricians and 

gynecologists, orthopedic surgeons, and otolaryngologists. 

A majority (60 percent) of visits to urologists were made by patients over 44 years of 

age (table 3). The median visit age (i.e., the age 

calculated from the distribution of visits rather 

than individual patients) was about 47 years, exceeding by 10 years the national median of 37 

years calculated from visits to all office-based 

physicians. An estimated 60 percent of visits to 

urologists were made by male patients (table 3), 

a proportion that substantially exceeded the 

average proportion of male visits found in overall office-based practice (40 percent). Indeed, 

urology is one of the few specialties where visits 

by males equaled or exceeded visits by females, 

the other notable exceptions being pediatrics, 

orthopedic surgery, and cardiovascular disease. 

The 19.8 percent of visits to urologists made 

by new patients is relatively high compared 

with the corresponding 14.6 percent found 

in overall office-based practice (table 3). Contributing in a large degree to this increased 

presence of new patients is the finding that 2 of 

Table 3. Nutier and percent distribution of office visits to 

urologists and percent distribution of office visits to all 

specialists by selected characteristics of the patient: United 

States, 1975-76 

Visits to- Nutier of 

Patient characteristic visits to 

urologists 

in thousands 

All Jrologists specialists 

I 

Percent distribution 

All visits ...... ..... 20,728 100.0 1100.0 

Aae 

Under 15 years, ................ 1,504 7.3 18.1 

15-24 years ....................... 1,539 7.4 15.1 

25-44 years, ...................... 5,228 25,2 25.5 

45-64 years ...................... 6,587 31.8 25.1 

65 years and over . ............ 5,870 28.3 16,2 

— 

sex

Female . .. . ..... . .. ... . . .... .. . ... .. 8,404 40.5 60.4 

Male, . ... ... .... .. .. .. .. . .... . .. .... . 12,324 59.5 39.6 

Prior visit status 

New patient . . .. .... . ... . .. ... .. . 4,108 19.8 14.6 

Old patient:. 

New problem .. ... . . .... . . 1,670 8.1 23.2 

Old problem ... .. .. .. ... .. . 14,849 72.1 62.3 

1 ~sed on an ~~timated 1.155,900,000 visits made to all 

office-based physicians in 1975 and 1976. 

every 5 of these visits by new patients were 

referrals from other physicians or agencies. This 

referraJ rate (8.4 percent of all the urologists’ 

visits) is more than triple the average rate of 2.6 

percent found for all office-based physicians. It 

is exceeded by only one other of the most-visited 

specialties—neurology. For the 5,779,000 visits 

at which a new problem was presented to the 

urologist (i.e., the 4,109,000 visits by new 

patients plus the 1,670,000 visits by old patients 

with new problems), tAere were 14,949,000 

return visits, art average of 2.6 return visits per 

new problem per year, a rate considerably higher 

than the average of 1.6 return visits found in 

overall office practice. Indeed, it was exceeded 

by only two others among the most-visited 

specialties-psychiatry and cardiovascular disease. 

Ten complaints or symptoms accounted for 

3 of every 5 visits to the urologist (table 4). The 
admceda3 

Table 4. Number. Dercent, and cumulative cwcent of office visits to urologists. bv the 10 most common complaints or svmmoms 

expressed by patients classified by NAMCS code and ranked ~y number of visits: United States, 1975-76 “ “ 

“Wsits to urologists 

Most common complaint or symptom and NAMCS codel Number in Percent 

thousands percent 

t.

... 

1 Symptoms referable to urinary tract NEC2 

(includes bladder trwble, passed *ones) .. ... .. . .. .. . .. ... . ... . .. .. . .. . ... . ... .. .. ... . .. ... ... . ...6~O 2,541 12.3 12.3 

2 Painful urination . .. ... .. .. . .. . .. .. .. . ... .. .. .. .. . .. ... .. ... ... .. .. . . .. .. . .... . .... .. . ... . . .... .... .. .. .. . .. .. . ...6M 2,211 10.7 23.0 

3 Frequency and nocturia .. .. . .. ... . . ... . . ... . ... .. ... .. . .. ... .. ..... . .. .. . . .... .. . ... . . .... . .. .. ... .. ... .. . ..Ml 1,936 9.3 32.3 

4 Symptoms referable to the male reproductive system other than male 

infertility, psychosexual problems, and pain, swelling, or mass of male 

genital system . .. . .. .. ... .. .. . .. .. .. .. . . .. .. ... .. .. . ... . . ... . .. .... .. ... . ..... .. ... . .. ... . .. .. ... .. .. . .. ... .. . ... 1,159 5.6 37.9 

5 Pain, swelling or mess of male genital system ... . .. .. ..... . . .... .. ... . .... .. .. ... .. .... .. . ... . .. ..63l 1,147 5.5 43.4 

6 Abdominal pain . .. . ... .. .. .. .. .. .. . ... .. . .. .. . ... . . ... .. .. ... .. ... . . .... .. ... .. ... . . .. .. .. .. ... .. . ... . . .. .. ... . ..W 830 4.0 47.4 

7 Urine abnormalities and abnormal consituents . .... .. .. .. . ... . .. ... . . .... .. ... . .... . .. .. ... . .. ...~ 805 3.9 51.3 

8 CM~~r~i;ry dysfunction (includes hesitancy, large VOIU me, slowing 

... .. .... .. ..... . . .. ... ... . .. .. .. .... .. .. .. ... .. . .. .. . .. ... . .. .. . . .... . . ... . . .... .. .. .. .. . ..... . .... .. ...61 O 714 3.4 54.7 

9 Incontinence of urine . .... . . ... . . ... . .. .. .. .... . .. . .. . ..... . .. .. . . ... . .. ... . .. ... . . ... .. . ... . .... . .. .. ... .. . .. 602 667 3.2 57.9 

10 Pain, swelling, injury of back region . .. .. . ... .. .. .. . .. .... . .. . ... ... . .. .. . .. .. . . . ... .. ... ... . .. ... . .. ..4l 5 565 2.7 60.6 

18ased on a symptom class~lcation developedfor use in NAMCS. 

2Not ~l=where &@fied. 

terms and codes applied to these complaints or 

symptoms come from a symptom classification 

developed for use in the National Ambulatory 

MedicaI Care Survey.z 

Of the complaints that patients presented to 

urologists, the majority (about 60 percent) 

signaled chronic conditions, i.e., preexisting conditions with an onset of 3 months or more 

before the visit. Although most of the visits for 

chronic conditions reflected a routine (maintenance) type of care, a relatively large proportion (two-fifths) were caused by a flareup of 

the condition, bringing to the urologist’s office 

practice much the same aspect of clinical immediacy found among specialitiessuch as general 

practice and pediatrics, where the emphasis is on 

acute morbidity—conditions with more recent 

onset and a more demanding and felt need for 

speedy attention. 

Table 5 presents data on the 10 principal 

diagnoses most frequently rendered by the 

2Nation~ Center for Health Statistics: The National 

Ambulatory Medical Care. Survey, Symptom Ckssification, by Sue Meads and Thomas McLemore. Vital and 

Health Statistics. Series 2-No. 63. DHEW Pub. No. 

(HRA) 74-1337. Health Resources Administration. 

Washington. U.S. Government Printing Office, May 

1974. 

office-based urologist. The principal diagnosis 

was the first-listed diagnosis -on a‘survey form 

that permits up to three diagnostic entries. 

Table 6 classifies all principal diagnoses 

made by urologists into major diagnostic groups. . 

Diagnostic classes and codes are those established by the Eighth Revision International 

Classa’’cation of Diseases, Adapted for Use in 

the United States (ICDA). One diagnostic finding distinctive to the urologist’s office practice is 

the relatively high frequency of neoplasms 

encountered there. Among the most-visited 

specialists (table 1), this frequency is exceeded 

by onIy two other specifllsts-dermatologists 

and general surgeons. 

To establish a diagnosis, office-based urologists-like most of their office-based counterparts-placed focal reliance on the limited history and examination (table 7), one limited to 

the body sites and systems specific to their 

scope of specialization, and concerned primarily 

with the patient’s chief complaint, painful 

urination, frequency, nocturia, and so forth. 

Urologists used laboratory tests about 3 times as 

often as the average office-based specialist, and 

their use of endoscopy (in 8.3 percent of visits) 

exceeded the use of these procedures by any of 

the 12 other most-visited specialists. Perhaps 

meriting attention is the relatively infrequent 
1

2

3

4

5

6

4 

Table 5. Number. . nercent, . and cumulative Dercent of office visits to urologists, by 10 principal diagnoses most frequently rendered 

classified by ICDA category and ranked by number of visits: United States, 1975-76 

Rank 

7 

8 

9 

10 

Most frequent diagnosis and ICDA codel 

Cystitis ... ... ................................................ ............. .......................................... ..595 

Stricture of urethra ......................................... ...................... .............................598 

Medical and surgical atiermre ......................... .......................................... ........Yl O 

Prostatitis ............................. ............................ .............. ................ ............ ...... .. 601 

Hyperplasia of pro~ate ... ................ .............. ................. ..................... ...............6~ 

Other diseases of urinary tract (includes infection NEC2; urinary f istulal; 

urethral ceruncle, diverticulitis, divert iculosis, false passage, rupture; male 

urethrocele ................................... ...... ............................... ..........5~.599.O.599.g 

Urethritis (nonvenereal) ........................................ ...... ............. ..........................597 

Malignant neoplasm of proWate ............ ................ ........................... ......... ..........l85 

Symptoms and illdefined conditions; symptoms referable to genitourinary 

system, e.g., pain, urinary system; retention and incontinence of urine; 

fraquancy of micturition; polyruia and oliguria; priapism and pain., 

genital organs ............... ............................. ..... ... ...........................7~.786.O.786.7 

Calculus of kidney and ureter ......................................... ..................... .............592 

Visits to urologists 

Number in Percent ;umulative 

thousends percent 

2,247 10.8 10.8 

2,075 10.0 20.8 

2,044 9.9 30.7 

1,927 9.3 40,0 

1,217 5.9 45.9 

1,200 5.8 51,7 

947 .4.6 56.3 

720 3.5 59.8 

705 3.4 63.2 

608 2.9 66.1 

United States (lCDA). 

presented to them, urologists 

—— 

1~~e,j on E@t], Revi~j~n In termtr’oml Classification of Diseases, Adapted for use in the 

number of occasions (about 14 percent of visits) 

at which a blood pressure reading was taken. 

Drug therapy was the treatment most frequently provided by urologists (table 7); they 

used it in about 40 percent of visits, a proportion that was roughly paralleled in overall 

office-based practice. Their use of surgical procedures in the office (in about 19 percent of visits) 

substantizdly exceeded the average frequency of 

office surgery among all specialists.3 

Table 8 presents data on the severity of the 

problems that patients presented to the urologist, expressing the doctor’s judgment of the 

extent of impairment that might result if no care 

were available. In close parallel to the average 

tendency among all office-based practitioners, 

urologists judged most of their patients’ problems (4 of every 5) to range from slightly serious to not serious in prognosis. 

Directly reflecting the chronic nature of 

31n he Nation~ Ambulatory Medical Care su~ey, 

office surgery is defined as “any surgical procedure performed in the office this visit, including suture of 

wounds, reduction of fractures, application/removal of 

casts, incision and draining of abscesses, application of 

supportive materials for fractures and sprains, and all 

irrigations, aspirations, dilatations, and excisions. ” 

most m-oblems 

ended’7 of every-10 visits by scheduling a return 

visit at a specified time (table 8). Th~ 7.1 percent of visits that ended in hospital admission 

Table 6. Number and percent distribution of office visits to 

urologists by principal diagnoses classified by major ICDA 

group: United States, 1975-76 

Principal diagnosis 

and ICDA codesl 

All principal diagnoses ..... 

Neoplasms ..................... ......140-239 

Diseases of the genitourinary 

system .......................... .....58O-628 

Symptoms and illdefined 

conditions ..... .................. ..78O-796 

Special conditions and examinations 

wkhout sickness [chiefly, surgical 

aftercare) ..... ............ ........YOO-Y1 3 

Other diagnoses classified chiefly 

in groups Accidents, poisonings, 

and violence and Infective and 

parasitic diseases,,..,., ........ Residual 

Visits to urologists 

Number in Percent 

thousands distribution ‘ 

20,728 100.0 

1,329 6.4 

12,639 61.0 

1,813 8.8 

2,754 13.3 

2,193 10.5 

1~5e~ on @#s~h Reviss.o~ItIternOtiO?M! (%ssifimtionof 

Diseases, Adapted for Use in the United States (ICDA). 
amcedaa5 

Table 7. Number and percent of office visits to urologists and 

percent of offiie visits to all specialists, by type of service 

provided: United states, 1975-76 

Type of service provided 

Diagnostic service 

Limited history and . . exammation ................... 

General history and 

examination ................... 

Clinical laboratory test .... 

x-ray ............................... 

Blood pressure check...... 

Endoscopy ...................... 

Therapeutic service 

Drug prescribed............... 

Injection ......................... 

Office surgery................. 

Medical counseling.......... 

Other services............ 

Visits to– Number of 

visits to All SP3- urologists Orologists ialistsl n thousands 

—. 

10,972 52.9 51.6 

2,758 13.3 16.3 

13,849 66.8 22.8 

1,819 8.8 7.6 

2,797 13.5 33.2 

1,727 8.3 1.2 

8,361 40.3 43.6 

552 2.7 13.1 

3,921 18.9 6.9 

1,881 9.6 13.0 

962 4.6 5.6 

lPercents based on an estimated 1,1 S5,900,000 visits made to 

all office-based physicians in 1975 and 1976. 

more than tripled the proportion (2.1 percent) 

common in overaII office-based practice. Indeed, 

it was the highest rate of hospital admission 

among all the 13 most-visited specialties. 

Data on duration of visit (table 8) revezd that 

the average face-to-face encounter between 

patient and office-based urologist lasted slightly 

more that 15 minutes; it did not differ substanti ally from the 15-minute average ca.lcul ated 

for all office-based specialists. 

Tabla 8. Nutier and percent distribution of office visits to 

urologists and percent distribution of office visits to aII 

specialists by selected visit characteristics: United states, 

1975-76 

Visits toNumber of 

visits to Visit characteristic urologists 

n thousends T 

All visits........... 

Seriousness of oroblem 

Serious and very serious... 

Slightly serious................ 

Not serious...................... 

Disposition 

(selected actions)z 

No followup ..................... 

Raturn at specified time... 

Return if needed.............. 

Telephone followup ......... 

Referred to other 

physician or agency........ 

Returned to referring 

physician ....................... 

#dmit to hospital ............ 

Duration of visit3 

1-5 minutes ...................... 

6-10 minutes .................... 

11-15 minutes .................. 

16-30 minutes .................. 

31 minutes or more .......... 

1 

Percent distribution 

20,728 100.0 1100.0 

4,105 19.8 19.2 

7,692 37.1 32.3 

8,931 43.1 4s.5 

766 3.7 12.3 

14,600 70.4 60.2 

3,603 17.4 21.9 

491 2.4 3.5 

578 2.8 2.8 

535 2.6 0.9 

1,481 7.1 2,1 

2,819 13.E 15.1 

6,000 28.C 31.5 

5,043 24.3 26.6 

5,763 27..5 19,5 

1,082 5.1 5.5 

lBased on an eatimeted 1,15 S,900,000 viaits made to all 

office-based physicians in 1975 and 1976. 

2~Eures ‘Wfi not add to totals because more thanone@ 

position was possible. 3Face.to-face encounter between physician and patient. 

SYMBOLS . 

Data not available —--—— . . -

Category not applicable— . . . 

Quantity zero– 

Quantity more than O but less than 0.05— 0.0 

Figure does not meet standards of 

reliabilityy or precision (more than * 30-percent relative standard emor)— 
......................................

..................

...............

................

...........

6


TECHNICAL NOTES 

SOURCE OF DATA: The information presented 

in this report is based on data collected in the 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS) during 1975 and 1976. The target universe of the NAMCS is comprised of office visits 

made within the coterminous United States by 

ambulatory patients to non-Federal physicians 

who are principally engaged in office practice 

and are not in the specialties of anesthesiology, 

pathology, or radiology. The National Opinion 

Research Center, under contract to the National 

Center for Health Statistics, was the organization responsible for the survey’s field operation, 

SAMPLE DESIGN: The NAMCS utilizes a multistage probability design that involves samples of 

primary sampling units (PSU’S), physician 

practices within PSU’S and patient visits within 

practices. Each year a sample of practicing 

physicians is selected from master files maintained by the American Medical Association and 

American Osteopathic Association. (For the 

2-year period 1975-76, a total of 180 urologists 

were included in the sample. They achieved a 

response rate of 85 percent. ) Characteristics of 

the physician’s practice, for example, primary 

specialty and type of practice, are obtained during an induction interview. The physicians are 

requested to complete Patient Records (brief 

encounter forms) for a random sample of office 

visits during a randomly assigned weekly reporting period.4 (In the 2-year period 1975-76, sampled urologists completed a total of 2,945 Patient 

Records.) A detailed description of the NAMCS 

design and procedures has been presented in an 

earlier publications 

SAMPLING ERRORS: Since the estimates for 

this report are based on a sample rather than the 

entire universe, they are subject to sampling vari4A facsimile of the Patient Record appears as figure 

L 

5 National Center for Health Statistics: The National 

Ambulato~ Medical Care Survey, 1975 Summary, 

United States, January-December 1975, by Hugo Koch 

and Thomas McI.emore. Vital and Eieaith Statistics. 

Series 1 3-No. 33. DHEW Pub. NO. (PHS) 78-1784. 

Public Health Service. Washington. U.S. Government 

Printing Office, Jan. 1978. . 

ability. The standard error is primarily a measure 

of sampling variability. The relative standard error of an estimate is obtained by dividing the 

standard error of the estimate by the estimate 

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard 

errors appropriate for the estimated percentages 

of the office visits are shown in table II. 

Table 1. Approximate relative standard error of estimated 

numbers of office visits, NAMCS 1975-76 

Estimate Relative standard 

in error in 

thousands percentage points 

600 . .. . 30.2 

1,000....................................... 23.5 

2,000 .... .. .. .. . . .. .. .. .. .. .. .. .... .. .. .. . . . 16.7 

4,000 .. .. .. .. . . ... .. . .. .. ... . .. .... . ... .. .. . 12.0 

10,000 ... ... . .. . ... .. .... .. .. .. .. .. .. .. .. .. 6.0 

40,0CI0 .. .. ... . . ..... . .. .. . .... .. .. ... ... . . . 4.8 

200,000 . ... . .... . . .... .. .. .... .. .... .. .. . 3.4 

l,OCIO,OOO .. ... .. ... ... .. . .... .. .. ... .. ... 3.1 

Example ofrme of table: An aggregate estimate of 25,000,000 

vMs has a retative standard error of 6.4 percent or a standard 

error of 1,600,000 viaits (6.4 percent of 25,000,000). 

Table Ii. Approximate standard errors of percentages fo! 

estimated numbers of office visits, NAMCS 1975-76 

Base of percentage Estimated percentage 

(number of visits 1 or 5 or 10or 20 or 30 or in thousands} 99 95 90 80 70 50 

Standard error in percentage points 

600 ........................ 3.0 6.5 9.0 

1,000 .. .................. . 2.3 5.1 7.0 

2,000 ........ ..... ...... .. 1.6 3.6 4.9 

4,000 ............... ...... 1.2 2.5 3.5 

Io,ooo . 0.7 1.6 2.2 

40,000 . . .. 0.4 0.8 1.1 

200,000 . 0.2 0.4 0.5 

1,000,000 . . . L0.1 0.2 0.2

12.0 13.8 15,0 

9.3 10,7 11.6 

6.6 7.5 8.2 

4.7 5.3 5,8 

2.9 3.4 3,7 

1.5 1.7 1.8 

0.7 0,8 0.8 

0.3 0.3 0.4 1 

Exampk of use of table: An estimate of 20 percent based on 

en aggregate estimate of 80,000,000 visits has a standard error of 

1.3 percent. The relative standard error of 20 percent is 6.5 (1.3 

percent + 20 percent). 

ROUNDING: Aggregate estimates of office visits 

presented in the tables are rounded to the nearest 

thousand. The rates and percents, however, were 

calculated on the basis of original, unrounded 
ackmd#a7 

Figure 1. PATlENT RECORD 

I

‘1. DATE OF VISIT PATlENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY m7%7+- . 

2. DATE OF BIRTtl 4. COLORon 5. PATEEWS -CWAL ~IS) 

SACE COMPUEEETIS). onsmmsm(s)~ m 6.	 -33SBESS OF 7. HAVE YOU EVER SEEN 

PaonsmEmETEmE# THIS PATIENT BEFORE? 

. 

, U VERY SERIOUS I � YES z13N0 

} 

~ � SERIOUS if YES, for the problem . . . 

, 0 sL,G~y ~R,ous lnd)c~~nd m ITEM 58? 

(CAUA One) 

I s •l NOT SERIOUS iIO YES lnNo 

FNYSFSFAWSPSMCIPAL 01A6FIOSFS~ VISIT 

a. DIAGNOSIS ASSOCIATE WITH ITEM 5a ENTRY 

b. OTHER SIGNIFICANT CURRENT OIAGNOSES 

(7. order of irnpadance) 

(l#p#ids #w* Xuis) 

I � WHITE +=7’+ — 

3.	 SEX ? O NEGRO/ � . MOST 

BLACK IMPORTANT 

I O FEMALE a IJ OTHER 

I lJ MALE . 0 UNKNOWN I b. OTHER I 

8.	 MAJOR REASON(S) FOR TINS — V333T(LWCi d/wjoJ rmc.ts)

_ 

9. 

,1 � ACUTE PROBLEM 

J: O ACUTE PROBLEM, FOLLOW-UP 

o> � CHRONIC PROBLEM. ROUTINE 

O* � CHRONIC PROBLEM, FLARE-UP 

.,% � PRENATAL CARE 

.)6 � POSTNATAL CARE 

., � POSTOPERATIVE CARE 

7 

I (Oc.emtke procedure] 

,,, ~ 

I! ~ 

.- @ 

,* ~ 

‘. n 

.‘ O 

.. G 

WELL *ouL~,~”,Lo *M 

FAMILY PLANNING 

COUNSELING/ADVICE


IMMUNIZATION


REFERRED BY OTHER PHYS/AGENCY


ADMINISTRATIVE PURPOSE


OTHER (S-Y)


10. DIA6NOSTIWTFEEEEAPEUTKSERVECESOROERE~OiEOEDTNES VSETICAa&sF~X) 11.o~mssnoaTENSmm 12. OURATION OF

{Cb9d AI*:	 a} ~ VISIT (Tim 

�ctuallyspentwifb 

)hysicim) 

, B NO FOLLOW-UP PIANNED 

z C R-RN AT SPECIFIED TIME 

~ � RETURN IF NEEOEO. P.R.N. 

4 i3 TELEpHONE FOLLOW-UP PIANNED 

s 0 REFERREO TO OTHER —MINUTES 

PHYSICIAN/AGE NCY ,. . iZ RETURNEO TO REFERRING 

PHYSICIAN 

7 ~ ADMIT TO HOSPITAL 

01 D NONE 11 � ORUG?RESCRED 

02 � LIMITEO W.STORYIEX4M 12 � x-RAY 

03 � GENERAL Ht3TORY/EXAN 13 � lN.EcTlm w � CLINICAL LAB. 7SS7 14 � lMWNlm~~TI~ 

05 0 BLOOO PRESSURE CHECK 1s c1 FNYSIDTHERAFY 

06 D EKG 16 � =DlfXL COU=LIN 

07 0 HEARING TSST 17 •1 FsYcHoTHsRAPvmFEA?ELrnc 

0s � VISION TssT LISTENING 

09 � EN~Y la a OTHER @dfvl 

10 n OFFICE SURGERY 

I

# � 17 OTHER (@eci&) 

1 

aND WI-FARE	 O.M.G. #68-S72106 

EXPIRATION OATE 12f31~5 RATION 

rATlsmcs 

HRA-34-3 DEPARTMENT OF HEALT~ ~_T,m 

REV. S-74 FWBLIC HEALTH SERVI 

HEALTH RSSOURCES -INIS 

NATIONAL CENTER FOR HEALTH 

figures. Due to rounding of percents, the sum of 

percentages may not equal 100.0 percent. 

DEFINITIONS: An ambul@ory patient is an irEdividual presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any health care institution on the 

premises. 

An office is a place that the physician identifies as a location for his ambulatory practice. 

Responsibility over time for patient care and 

professional setices rendered there generally 

resides with the individual physician rather than 

an institution. 

A visit is a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working under the physician’s supervision for the purpose of seeking care and 

rendering health services. 

A phya”cian is a duly licensed doctor of 

medicine (M.D.) or doctor of osteopathy (D.O.) 

currently in practice who spends time in caring 

for ambulatory patients at an office location: 

Excluded from NAMCS are physicians who 

specialize in anesthesiology, pathology, radioIogy; physicians who are federally employed; 

physicians who treat only institutionalized 

patients; physicians employed full time by an 

institution; and physicians who spend no time 

seeing ambulatory patients. 
FROM VITAL & HEALTH STA T/STICs OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE w Publlc Health Service I N.mber40¤ Septwnber 22,1978 

Contraceptive Utilization Among Widowed, Divorced, and 

Separated Women in the United States: 1973 and 19761 

INTRODUCTION 

The data presented in this report are the 

latest nationwide statistics on contraceptive utilization from the 1’976 and 1973 National Surveys of Family Growth conducted by the 

National Center for Health Statistics. The data 

were collected by means of personal interviews 

with a multistage probability sample of women 

15-44 years of age in the noninstitutionalized 

population of the conterrninous United States. 

Women were eligible for inclusion in the sample 

if they were currently or previously married or 

were never married but had offspring presently 

living in the household. 

The interview focused on the respondents’ 

marital and pregnancy histories, their use of contraception and the planning status of each pregnant y, their intentions regarding number and 

spacing of future births, their use of maternal 

care and family planning services, and on a 

broad range of social and economic characteristics. Between June 1973 and February 

1974, 3,856 black women and 5,941 women of 

others races were interviewed for Cycle I. 

Between January and September of 1976,2,946 

black women and 5,665 women of other races 

were interviewed for Cycle IL Further discussion 

of the survey design, definition of terms, and 

sampling variability are in the TechnicaI Notes.

Among the estimated 3.6 million widowed, 

divorced, and separated, or postmarried, women 

of childbearing age (15-44 years) in the United 

States in 1976, about 1.2 million, or one-third, 

1This report was prepared by Kathleen Ford, Ph. D., 

Division of Vital Statistics. 

were sterile and another 1.6 million, or nearly 

one-half, were using some method of cont rac eption other than surgical sterilization. 

These figures reflect substantial changes in a 

period of 3 years; in 1973 just over one-fifth of 

currently postmarried women in the childbearing ages were sterile and only 30 percent 

reported using some method of contraception. 

The increase in the proportion reporting use of 

contraception other than surgicaI sterilization 

quite likely reflects greater candor in responding 

to these surveys as much as any actuaI increase 

in contraceptive practice. These data are comparable with those recently published for currently married women in the United States.z 

CONTRACEPTIVE STATUS OF WIDOWED, 

DIVORCED, AND SEPARATED WOMEN 

The frequency of sterility has increased substantially more among wjdowed, divorced, and 

separated women between 1973 and 1976 (1 1.4 

percentage points) than among currently married women (6.4 percentage points), resulting in 

a Water ProPortion sterile among the Postmarried (32.8 percent) than among the currently 

married (30.2 percent) in 1976.2 These observations are true for bot~ surgical and nonsurgical 

sterility, though the latter comparison is not statistically significant. While there were more 

surgical sterilizations for contraceptive than for 

noncontraceptive reasons among both currently 

2National Center for Health Statistics: “Contraceptive UtiEzation in the United States: 1973 and 

1976,” ADVANCE DATA, No. 56, August 18, 1976. 
2


married and postmarried women, the postmarried women reported a higher proportion of 

noncontraceptive sterilizations and a lower proportion of contraceptive ones. 

The very large decline in the porpotion of 

noncontraceptors among postmanied women 

between 1973 and 1976 is anomalous (tabIe I). 

There was no statistically significant change in 

the proportions who were pregnant, post 

partum, or trying to become pregnant, and, as 

e x petted, these porportions were markedly 

Table 1. Number of widowed, divorced, and separated women aged 

lower among postmarried women than among 

currently married women. The proportions of 

“other nonusers’’—noncontraceptors for reasons 

unrelated to pregnancy-are much larger among 

postmarried women than among crirrentl~’ mwned women but account for virtuaI1y all of the 

decline in noncontraccptors among the posl -

married between 1973 and 1976 (25.6 percentage points). While a major part of this 

decline can be attributed to the increase in stcrilizations noted above, more than half of it is 

15.44 and percent distribution by contraceptive status, according to 

race: United States, 1973 and 1976 

Totall White Black 

Contraceptive stat us 

1976 1973 1976 1973 1976 1973, 

I Number in thousands2 

All womn ................................................................................. 3,601 I 3,601 JI 2,516 I 2,646 J 1,031 I 1,028 

I Parcent distribution 

Total ...................... ............................. ........................................... 

Sterile women 

All sterile women ....................... ......... ............................................. 

Fecund women 

Noncontraceptors: 

Pregnant, post partum, seeking prqmncy ... ......................................... 

Other nonusers ............ ... ...................................................................... 

co nt raceptors: 

All methds ............................................................... ................... .. 

Oral contraceptive pill ..................................... .......................................... 

Intrauterine device (IUD) ............................................ .............................. 

Diaphragm ........... ............................ ..................................... ............. ........ 

tindom .......................... ........................................................................... 

Foam .......................... ..................................... ................ .......................... 

Rhythm .. ......... ............................................... ......... .................................. 

Withdrawal ................................ ..................................... ........................... 

Douche .................................... ............. .............................. .............. ......... 

Other .......... ................... ................ ............................ ................................ 

100.0 100,0 100.0 100.0 100.0 100.0 

32.8 21.4 32.3 20.3 33.7 24.4 

2.7 90.5 2.3 “0.3 3.2 ‘0.9 

30.1 20.9 29.9 19.9 30.4 23.5 

13.7 8.4 14.0 8.6 13.6 8.2 

16.4 12.3 15.9 11.1 16.8 15.3 

2.0 2.9 1.6 2.3 3.1 4.5 

19.7 45.3 17.7 47.4 23.7 39.2 

45.4 30.4 48.4 30.1 39.5 31.9 

28.0 18.1 30.8 18.6 21.3 i7.2 

9.1 7.2 9.4 7.0 8.8 7.9 

1.2 1.3 1.2 1.5 �1.3 ‘0.6 

1.8 *0.9 1.9 1.1 �1.6 90.5 

1.4 *0.7 1.2 ‘0.4 �1,9 ‘1 .6 

1.2 �o .4 1.5 “0.4 40.7 ‘0.4 

�0.3 “0.3 ‘0.4 �1.O “0.0 

1.0 �0.3 1,0 *1.2 *1.1 

1.4 1.2 1.3 ‘0.7 �1.5 2.5 

lIncludes ~hfie, black, and other races. 

2 In the 1973 fjgure~, ~5timate~ of the number Of women in thoumnds include kases fOr which contraceptive Status was not ascertain 

but was imputed. C)nly those cases m which contraceptive status was ascertained are included in the 1976 figures. See Technical Notes. 
akEedaa3 

reflected in the increase in number of women 

using methods other than sterilization. 

The proportion of contraceptors among the 

post married rose 15.0 percentage points from 

1973 to 1976, reaching 45.4 percent-only 3.2 

p¢ below the proportion of contraceptors 

among currently married women in tl~at year. 

These figures may reflect an increase in sexual 

activity among the postmarried or, more plausibly, a greater candor in discussing these topics 

anonymously. However, there was also a change 

in intemiewer instructions in 1976 which could 

have influenced these figures. A more detailed 

analysis of contraceptive practices which examines these possibilities will be published in series 

23 of Vital and Healtlz Statistics. 

Among currently married women, the resort 

to surgical sterilization has resulted in a higher 

frequency of sterility among white compared 

with black women. However, for the postmarried, sterility from both surgical and nonsurgical causes is higher among black women, 

Table 2. Number of widowed, divorced, and separated women aged 

though the difference diminished greatly 

between 1973 and 1976 because of the larger 

increase among white women. 

Looking at contraceptors exclusive of those 

with contraceptive sterilizations (table 2), it is 

seen that use of the modem methods (pill and 

IUD) in both 1973 and 1976 was stnkmgly 

higher among postmarried womeri (83.4 and. 

81.6 percent in the respective years) ~thanamong 

currently married women (59.7 and 58.5 percent, respectively). The alight decline observed 

in the use of the oral contraceptive ‘pill between 

1973 and 1976 among currently married 

women—particularly among black women—did 

not appear among the post married women of 

either race. The distinct shift back to traditional 

methods observed among currently married 

black contraceptors between 1973 and 1976 

(12.9 percentage points) also was not observed 

among postmarried black contraceptors (a statistically nonsignificant shift of only 2.4 percent). 

1544 using contraception and percent distribution by cixrtraceptive 

method according to race: United States, 1973 and 1976 

Contraceptive method 

All contraceptors ............. .................... ..................................... 

Total ................. .... ............................ ........ ................. ........... .......... 

Oml contraceptive pill ..... ......... ..... ........... ............. .................................... 

Intrauterine device (IUD) . ..................................................... ..... ..... .......... 

Dbphragm ........................... ................ ....... ..... .......................................... 

Condom ............................... ....................... .................. ................. ............. 

Foam .............................. ............................. ..................... ......................... 

RhWhm ........................................... .. ... ....... .... ........ .................................. 

W~hdrawal ......................................................................... .. ............ ......... 

buche ............................................................................ .... ...................... 

I 11 r 

Totall White Black 

1976 1973 1976 1973 1976 1973 

Nu”mber in thousands2 

1,636 1,0821] 1,217 763 407 328 

Percent d is.tr.kmtion Rm

3.0 2.4 24 �1.3 

2.7 “1.3 3.1 �1 .3 �1.8 *1 .4 

“0.6 �0.9 - �1.2 2.5 �0.2 

2.2 �1.O 2.0 - 3.1 3.4 

3.0 3.6 2.8 �1.7 3.8 7.9 

4.8 5.0 

I I II I I I 

lln~]udes white, black, and other races. 

21n the 1973 fisures, estimates of the number of women in thousands include cases for which contraceptive SWU5 VVaS not ascertained 

but was imputed. Only those cases in which contraceptive status was ascertained are included in the 1976 fgures. See Technical Notes. 
4 &rlcdEl@ 

TECHNICAL NOTES 

The Survey Design 

The National Survey of Family Growth 

(NSFG) is designed to provide data on fertility, 

family planning, and related aspects of maternal 

and child health. Fieldwork for Cycle I was 

carried out by the hTational Opinion Research 

Center between June 1973 and February 1974. 

Fieldwork for Cycle II was carried out by 

Westat, Inc., between January and September of 

1976. 

A multistage probability sample of women 

in the noninstitutiona.lized population of the 

conterminous United States was used in both 

cycles. Each time, approximately 33,000 households were screened to identify the sample of 

women who would be eligible for hTSFG, i.e., 

women between the ages of 15 to 44 years, inclusive, who were currently married or previously married or who were never married but 

had offspring presentl~ living in the household. 

In households with more than one eligible 

woman, a random procedure was used to select 

only one to be interviewed. Since the interviews 

were always conducted with the sample person, 

the term “respondent” is used as synonymous 

with sample person. For Cycle 1, interviews were 

completed with 3,856 black women and 5,941 

women of other races. For Cycle 11, interviews 

were completed with 2,946 black women and 

5,665 women of other races, A detailed description of the sample design for Cycle I is 

presented in “National Survey of Family 

Growth, Cycle I: Sample Design, Estimation 

Procedures, and Variance Estimation, ” Series 2, 

Number 76, in the Vital and Health Statistics 

series. A similar report is in preparation for 

Cycle H. 

The interview was focused on the respondent’s marital and pregnancy histories, on 

the use of contraception and the planning status 

of each pregnancy, on the respondent’s intentions regarding the number and spacing of 

future births, on maternal and family planning 

services, and on a broad range of social and 

economic characteristics. While the intemiews 

vaned greatly in the time required for their completion, they averaged about 70 minutes for 

Cycle I and about 58 minutes for Cycle H. 

Quality control procedures were applied at 

all stages of the survey. These included a verification of listing completeness with unlisted 

dwelling units being brought into the sample, a 

preliminary field review of completed questionnaires for possible missing data or inaccurate 

administration, a 10-percent sample recheck of 

all households to be screened in the survey, observation of interviews in the field, and an independent recoding of a 5-percent subsample of 

completed interviews. 

Reliability of Estimates 

Since the statistics presented in this repor~ 

are based on a sample, they may differ somewhat from the figures that would have been 

obtained if a complete census had been taken 

using the same questionnaires, instructions, interviewing personnel, and field procedures. This 

chance difference between sample results and a 

complete count is referred to as sampling error. 

In addition, the results are also subject to non 

sampling error due to respondent misrepc)rting, 

data processing mistakes, and nonresponse. It is 

very difficult, if not impossible, to obtain ac: 

curate measures of nonsampling errors. These 

types of error were kept to a minimum by thr 

quality control procedures and other methc)cls 

incorporated into the survey design and tidministration. 

~ 

\ Sampling error, or the extent to which 

samples may differ by chance from a complctc 

count, is measured by a statistic called the standard error of estimate. Approximate. standard 

errors for estimated numbers and percentages 

from Cycle I are shown in tables I and II for the 

total and white populations and in tables 111and 

IV for the black population. Provisional estimates for standard errors for Cycle 11 for total 

and white women can be obtained by multiplying the standard errors for these women from 

Cycle I by a factor of 1.1. Similarly, provisional 

estimates of standard errors for Cycle H for 

black women can be obtained by multiplying 

the standard errors for these women from Cycle 

I by a factor of 1.2. 

The chances are about 68 out of 100 that an 

estimate from the sample would differ from. a 

complete census by less than the standard error. 

I 
.......

admcdda5 

Table 1. Approximate Sandard errors for estimated numbers for Table IV. Approximate standard errors for estimated percentages 

white and total women: 1973 National Survav of Familv .—Growth	 expressed in percentage points for black women: 1973 

National survey of Family Growth 

Relative Sizeof Standard standard Estimated percentage estimate error error Bssse of

percentage 2 or 5 or O or 20 or 30 or 40 or 50 

50,000 ............................ ...... 30.0 15,000 

100,000................................ 21.2 21,000 

200,000................................ 15.0 30,000 5,000............... 7.9 12.3 17.01 22.6 25.9 27.7 28.3 

500,000................................ 9.5 47,000 1O,mo............. 5.6 8.7 12.0 16.0 18.3 19.6 20.0 

I,ooo,ooo ............................. 6.7 67,000 50,000............. 2.5 3.9 5.4 7.1 8.2 8.8 8.9 

2,000,000............................. 4.8 95,000 100,000........... 1.8 2.7 3.8 5.1 5.8 6.2 6.3 

5,000,000............................. 3.0 151,000 300,000........... 1.0 1.6 2.2 2.9 3.3 3.6 3.6 

Io,ooo,ooo ......................”... 2.2 216,000 500,000........... 0.8 1.2 1.7 2.3 2.6 2.8 2.8 

20,000,000........................... 1.5 311,000 700,000........... 0.7 1.0 1.4 1.9 2.2 2.3 2.4 

1,000,000........ 0.6 0.9 1.2 1.6 1.8 2.0 2.0 

98 95 T 80 80 70 60

Table 11. Approximate standard errors for estimated percentages 

expressed in Percentage points for white and total women: 

1973 National Survey of Family Growth. 

estimated. In this report, numbers and perEstimated percentage centages which have a standard error that is 

Base of T more than 25 percent of the estimate itself are 

percentage 2or 5or 0 or 20 or 30 or 40 or !50 considered “unreIiabIe.” They are marked with 

98 95 90 80 70 60 

an asterisk to caution the user but may be combined to make other types of comparisons of 

100,000........... 3.0 4.6 6.4 8.5 9.7 10.4 10.6 greater precision.

500,000.......... 1.3 2.1 2.8 3.8 4.3 4.6 4.7 In this report, terms such as “similar” and 1,000,000 . 0.9 1.5 2.0 2.7 3.1 3.3 3.3 \ 3,000,000........ 0.5 0.8 1.2 1.5 1.8 1.9 1.9 “the same” mean that any observed difference 

. 5,000,000........ 0.4 0.6 0.9 1.2 1.4 1.5 1.5 between two estimates being compared is not , 7,000,000........ 0.3 0.5 0.8 1.0 1.2 1.2 1.3 statistically significant. Similarly, terms such as 10,000,000...... 0.3 0.5 0.6 0.8 1.0 1.0 1.1 

f “greater,” “less,” ‘larger,” and “smaller” indicate that the observed differences are statisTable I I 1. Approximate standard errors for estimated numbers tically significant. The normal deviate test with a 

for black women: 1973 National Survev for Familv Growth .05 level of significance was used to test all comI parisons which are discussed in the text. A statisSize of -

est iriwte standard 

error 

Standard 

error 

tically significant difference is one large enough 

that in repeated samples of the same size and 

type as this one such a Iarge difference would be 

25,000 .. . .. ... .. .. .. ... . ... ... .... . .. .. . 25.3 6,000 expected to be found in less than 5 percent of 

50,000.................................. 17.9 9,000 the samples. Lack of comment in the text 

100,000................................ 

150,000................................ 

250,000................................ 

12.7 

10.3 

. 8.0 

13,000 

16,000 

20,000 

between any two statistics does not mean the 

difference was tested and found not to be signifRelative 

350,000................................ 6.8 24,000 icant.


500,000................................ 5.7 28,000 Adjustment for nonsampling error due to


750,000................................ 4.7 35,000


1,000,000............................. 4.0 40,000 nonresponse was made in two ways. Nonrespondent cases, as distinct from missing data 

items, were imputed by weighting for nonresponse within each primary sampling unit, 

The chances are about 95 out of 100 that the stratum, and age-race category. In the 1973 surdifferences between the sample estimate and a vey, codes for missing items were imputed using 

complete count would be less than twice the a “hot deck” procedure. In the 1976 survey, 

standard error. The relative standard error is the imputation for missing data items has not been 

ratio of the standard error to the statistic being performed and the figures in the tables are based 
6


only on those intemiews where enough information was obtained from the respondent to 

determine contraceptive status. As a result, in 

the 1976 figures, about 1,061,000 women out 

of an estimated 31,847,000 total ever-married 

women are not represented. 

DEFINITIONS OF TERMS 

The following definitions are applicable to all 

women in the survey, regardless of marital 

status. 

Sterile 

Steri/e.–A woman (or couple) was classified 

as sterile if she reported that it was impossible 

for her to have a baby. 

Non.rurgical.-A woman (or couple) was 

classified as nonsurgically sterile if she reported 

that it was impossible for her to have a baby for 

any reason other than a sterilizing operation. Reported nonsurgical reasons for sterility included 

menopause and sterility due to accident, illness, 

or congenital causes. 

Surgical.–A women (or couple) was classified as surgically sterile if she or her husband 

were completely sterile due to an operation. 

Since sterilizing operations are very frequent 1y obtained exclusively or partly as 

methods of contraception, i.e., because of their 

complete effectiveness against conception rather 

than for purely therapeutic reasons, they have 

been further classified as contraceptive and noncontraceptive. In Cycle I, a sterilizing operation 

was contraceptive if the respondent answered 

“yes” to the question ‘Was the operation done 

at least partly so that you would not have any 

more children?” Since the avoidance of more 

children (conceptions) could itself be for therapeutic reasons, the question was reworded in 

Cycle 11 to “Was one reason for the operation 

because you had all the children you wanted?” 

This change in wording was expected to yield a 

lower percent of operations reported for contraceptive reasons than would have been reported previously. As a result, the percents of 

couples with contraceptive and noncontraceptive sterilization shown in this report are not 

completely comparable between the two surveys. Mo, there is evidence that sterilizing 

operations classified as noncontraceptive may include some that actually were at least partly 

contraceptive in intent. The percent classified as 

contraceptive should therefore be regarded as a 

minimum estimate. Because of these limitations 

on the data, sterilizations for contraceptive reasons are reported with other causes of sterility 

and not, as formerly, with other methods of 

contraception. 

Fecund-Noncontraceptors 

Pre~ant.-A woman (or couple) was classified as pregnant if she replied affirmatively to 

the question “Are you pregnant now?” or for 

those in doubt, “DO you think you probably arc 

pregnant or not?” A woman who reported that 

the onset of her last menstrual period was within 

the 30 days prior to the interview was automatically considered not pregnant. 

Seeking pregnancy .-A woman (or couple) 

was classified as seeking pregnancy if she reported she was not using a method at the time 

of interview because she wanted to become 

pregnant. I 

Post partum.–A worn an (or couple) was 

classi~led as post partum if she reported she was 1 

not currently using a method, was not seeking a 

pregnancy, and her Iast pregnancy had ter- ; 

minated within 2 months before the date she 

was interviewed. 

(?ther nonusem.-Women (or couples) who 

reported they were currently using no COritraceptive method and could not be classified in ) 

any of the preceding categories of noncon ­

traceptors were classified here. Among these are I 

wonien who were indifferent to the chances of I 

pregnancy, had a very low risk of pregnancy due 

to some fecundity impairment, or objected to 

contraceptive methods for personal or religious 

reasons. Among the widowed, divorced, and 

separated, infrequent intercourse or complete 

abstinence probably accounts for a significant 

proportion of nonusers. Women who used the 

douche following intercourse, but who did r-sot 

report this as a method of contraception, were 

also classified here although suc~ douching 

practice is known to have a very modest contraceptive effect when done very soon after 

intercourse. 
---

dEmacMa7 

Fecund-Contraceptors 

Method users.-A woman (or couple) who 

reported use of a contraceptive method other 

than a surgical sterilization at the date of interview was classified according to the specific 

method used. Methods used by extremely sma!l 

proportions of the population such as jelly, 

cream suppositories, or abstinence, not in combination with any other methods, were grouped 

in the category “Other.” Where more than one 

method was reported in current use, the method 

generally considered the most effective was used 

for classification purposes. 

Demographic Terms 

Age.–In this report, age is classified by the 

age of the respondent at her last birthday before 

the date of intemiew. 

! Race. –Classification by race, based on interviewer observation, was reported as black, white, 

or other. Race refers to the race of the woman 

interviewed. 

Man-tal status.-Persons are classified by 

marital status as married, widowed, divorced, 

separated, ‘or never married or as informally 

married, such as living with a partner or common-law spouse. Persons who are temporarily 

separated for reasons other than marital discord, 

such as vacation, illness, or Armed Forces, are 

classified as married. Divorced persons are those 

whose most recent marriage has been legally dissolved and who are free to remarry. Women with 

an annulled marriage, while having the legal 

status of never having been married, are classified together with divorced women. The category “separated” includes those who are legally 

or informally separated from their most recent 

spouse due to marital discord. The “never 

married” include those who have never had a 

formzd marriage and do not consider themselves 

in any of the preceding categories. However, in 

the NSFG, only single women with offspring living in the household are included and separately 

ck+ssified. 

SYMBOLS 

Data not available -——

Category not applicable—————— . . . 

Quantity zero 

Quantity more than O but less than 0.05— 0.0 

Figure does not meet standards of 

* reliability or precision 

* U.S.GOVERNMENT PRINTING OFFICE:19W –.261 -195 ‘2O 009


1 
The annzaal national 

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Health, 

united states, 

1989 

and 

Prevention 

Profile 

The National Center for Health Statistics has 

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comprehensive volume presents easy-to-read 

and up-to-date facts and statistics in one 

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The 1989 edition contains 

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facets of America’s health. 

the latest data and 

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The 

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Thank you for your order! 
Vital and Health Statistics 

series descriptions 

SE RIES1. Programs and Collection Procedures—Reports describing 

the general programs of the National Center for Health 

statktiCS and its offices and divisions and the data COI. 

Iection methods used. They also include definitions and 

other material necessary for understanding the data. 

SERIES 2. Data Evaluation and M’ethods Research—Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to 

statistical theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

SERIES 3. Analytical and Epidemiological Studies—Reports preI senting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

i the expository types of reports in the other series. 

SERIES4. Documents and Committee Reports-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

SERIES 5. Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

SERIES 6. Cognition and Survey Measurement— Repons from the 

National Laboratory for Collaborative Research in Cognition and Survey Measurement using methods of cognitive 

science to design, evaluate, and test survey instruments. 

SERIES 10.	 Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

SERIES 11. Data From the National Health Examination Survey and 

the National Health and Nutrition Examination Survey— 

Data from direct examination, testing, and measurement 

of national samples of the civilian noninstitutiona lized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements without reference to 

an explicit finite universe of persons. 

SERIES 12.	 Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13. 

SERIES 13.	 Data on Health Resources Utilization—Statistics on the 

utilization of health manpower and facilities providing 

long-term care, ambulatory care, hospital care, and family 

planning services. 

SERIES 14,	 Data on Health Resources: Manpower and Facilities— 

Statistics on the numbers, geographic distribution, and 

characteristics of haalth resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15.	 Data From Special Surveys-Statistics on health and 

health-related topics collected in special surveys that 

are not a part of the continuing data systems of the 

National Center for Health Statistics. 

SERIES 16.	 Compilations of Advance Data From Vital and Health 

Statistics—These reports provide early release of data 

from the National Center for Health Statistics’ health and 

demographic surveys. Many of these releases are followed 

by detailed reports in the Vital and Health Statistics 

Series. 

SERIES 20.	 Data on Mortality-Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; 

and statistics on characteristics of deaths not available 

from the vital records based on sample surveys of those 

records. 

SERIES 21.	 Data on Natality, Marriage, and Divorce—Various statistics on natal ity, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

SERIES 22.	 Data From the National Mortality and Natality Surveys— 

Discontinued in 1975. Reports from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

SERIES 23.	 Data From the National Survey of Family Growth— 

Statistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of women 15-44 years of age. 

SERIES 24.	 Compilations of Data on Natality, Mortality, Marriage, 

Divorce, and Induced Terminations of Pregnancy— 

Advance reports of births, deaths, marriages, and divorces 

are based on final data from the National Vital Statistics 

System and are published annually as supplements to the 

Monthly Vital Statistics Report (MVSR). These reports are 

followed by the publication of detailed data in Vital Statistics of the United States annual volumes. Other reports 

including induced terminations of pregnancy issued periodically as supplements to the MVSR provide selected 

findings based on data from the National Vital Statistics 

System and may be followed by detailed reports in Vital 

and Health Statistics Series. 

For answers to questions about this report or for a list of titles of 

reports published in these series, contact 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Centers for Disease Control 

Public Health Service 

Hyattsville, Md. 20782 

301 -436–8500