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The importance of having a usual source of health care

Most people (82%) in the United States have and use for much of their health care a usual source of care, and a majority of them name a particular primary care physician as that source. Regardless of self-reported health status, people benefit from having a usual source of health care even if they are uninsured.

Fryer GE, Dovey SM, and Green LA

The Medical Expenditure Panel Survey (MEPS) is a national probability survey sponsored since 1996 by the Agency for Health Care Policy and Research. As part of this survey, trained interviewers determine whether or not each individual in respondents’ families has a usual source of health care. If so, the source is determined and characterized and other data can be analyzed accordingly. MEPS data when weighted for survey design complexities can be used for inference to the general U.S. population, as has been done here.

In 1996, 82% of Americans had a usual source for getting health care. These individuals would go to this usual source for new health problems (97%), preventive care (96%), and to seek referral for specialty services (96%). Approximately 56% regarded an individual professional, rather than a facility, as their usual source of care and of these: 62% identify a family physician, 16% a general internist, and 15% a pediatrician, leaving all other provider types as the usual source of care for only 8%.

Although there were virtually no differences in self-reported physical and mental health status comparing individuals with and without a usual source of care, profiles of utilization differed:

Profiles of Utilization

  Have Usual Source No Usual Source
Had difficulty obtaining care 11% 17%
Did without needed services 6% 12%
Had a doctor’s office visit 75% 39%
Admitted to hospital 8% 4%
Purchased any prescription medicine 70% 38%

 

Results from this survey indicate that 17% of Americans were uninsured. Of these, 62% could identify a usual source of health care. Most such inferences from MEPS data to the U.S. population can be made with substantial confidence. For example, the estimate of 17% of Americans without insurance, has a standard error of just 0.47%.

Comment: The 1996 MEPS suggests that most Americans are accustomed to having a usual source of care, and many can name a particular primary care physician as that source. They expect to go to their usual source for a wide range of services, and they use more health care services when they have one. Interestingly, being uninsured does not preclude having a usual source of care. From the viewpoint of patients, this is consistent with a usual source of care being a good thing.

Fryer GE, Dovey SM, Green LA. The importance of having a usual source of health care. Am Fam Physician 2000;62:477.

August 2000