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The Case for Synergy Between a Usual Source of Care and Health Insurance Coverage

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Abstract

BACKGROUND

In 2010, the United States (US) passed health insurance reforms aimed at expanding coverage to the uninsured. Yet, disparities persist in access to health care services, even among the insured.

OBJECTIVE

To examine the separate and combined association between having health insurance and/or a usual source of care (USC) and self-reported receipt of health care services.

DESIGN/SETTING

Two-tailed, chi-square analyses and logistic regression models were used to analyze nationally representative pooled 2002–2007 data from the Medical Expenditure Panel Survey (MEPS).

PARTICIPANTS

US adults (≥18 years of age) in the MEPS population who had at least one health care visit and who needed any care, tests, or treatment in the past year (n = 62,067).

MAIN OUTCOME MEASURES

We assessed the likelihood of an adult reporting unmet medical needs; unmet prescription needs; a problem getting care, tests, or treatment; and delayed care based on whether each individual had health insurance, a USC, both, or neither one.

KEY RESULTS

Among adults who reported a doctor visit and a need for services in the past year, having both health insurance and a USC was associated with the lowest percentage of unmet medical needs, problems and delays in getting care while having neither one was associated with the highest unmet medical needs, problems and delays in care. After adjusting for potentially confounding covariates (age, race, ethnicity, employment, geographic residence, education, household income as a percent of federal poverty level, health status, and marital status ), compared with insured adults who also had a USC, insured adults without a USC were more likely to have problems getting care, tests or treatment (adjusted relative risk [aRR] 1.27; 95% confidence interval [CI] 1.18–1.37); and also had a higher likelihood of experiencing a delay in urgent care (aRR 1.12; 95% CI 1.05–1.20).

CONCLUSIONS

Amidst ongoing health care reform, these findings suggest the important role that both health insurance coverage and a usual source of care may play in facilitating individuals’ access to care.

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Acknowledgements

We also wish to acknowledge the thousands of individuals who participated in the MEPS.

Funding Sources

This project was directly supported by grants 1 K08 HS16181 and 1 R01 HS018569 from the Agency for Healthcare Research and Quality (AHRQ) and the Oregon Health & Science University Department of Medicine. This publication received indirect support, from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

These funding agencies had no involvement in the design and conduct of the study; analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. AHRQ collects and manages the Medical Expenditure Panel Survey.

Presentations

An abstract with similar findings was presented at the North American Primary Care Research Group Annual Meeting in Seattle, Washington, November 2010.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA

    Jennifer E. DeVoe MD, Carrie J. Tillotson MPH & Heather Angier MPH

  2. Center for Researching Health Outcomes, Mercer Island, WA, 98040, USA

    Sarah E. Lesko MD, MPH

  3. Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA

    Lorraine S. Wallace PhD

Authors
  1. Jennifer E. DeVoe MD
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  2. Carrie J. Tillotson MPH
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  3. Sarah E. Lesko MD, MPH
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  4. Lorraine S. Wallace PhD
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  5. Heather Angier MPH
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Corresponding author

Correspondence to Jennifer E. DeVoe MD.

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DeVoe, J.E., Tillotson, C.J., Lesko, S.E. et al. The Case for Synergy Between a Usual Source of Care and Health Insurance Coverage. J GEN INTERN MED 26, 1059–1066 (2011). https://doi.org/10.1007/s11606-011-1666-0

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  • DOI: https://doi.org/10.1007/s11606-011-1666-0

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