Abstract
The “Ecology of Medical Care,” initially published in 19611 and updated in 2001,2 offers a framework to explore trends in the choices that patients make in seeking medical care. Understanding how individual persons seek care offers insight into the persistence of patterns despite dramatic changes in the organization and financing of health care.3 In addition, it may reveal intractable disparities between demographic groups in the use of health care.4 Given the substantial changes in health care delivery since 2001 and the availability of new data, we sought to update and expand the model.

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