A Medical Home Versus Temporary Housing: The Importance of a Stable Usual Source of Care

Abstract

Introduction Recent health care reform policies focus on finding the best medical home for everyone. Less is known about how the stability of a usual source of care (USC) over time impacts on structural access to care. Objectives To examine the prevalence of USC changes among a low-income population of children, and how these changes were associated with unmet need. Design and Methods Cross-sectional, multivariable analyses of mail-return survey data from Oregon's food stamp program in January 2005. Results from 2,681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling and non-response. The independent variable: whether a child had ever been required to change USC for insurance reasons. Dependent variables included: parents report of unmet medical need, unmet prescription need, missed medication doses, delayed urgent care, no ambulatory visits; and problems obtaining dental care, specialty care and counseling. Results Nearly 23% of children had changed their USC due to insurance reasons, and 10% had no current USC. Compared to children who had maintained a stable USC, children who had changed their USC due to insurance reasons had higher rates of unmet medical need (unadjusted odds ratio [OR] 2.69, 95% confidence interval [CI] 1.83, 3.29); unmet prescription need (OR 1.85, 95% CI 1.31, 2.61); delayed care (OR 1.87, 95% CI 1.21, 2.89); and reported more problems obtaining dental care (OR 1.66, 95% CI 1.20, 2.31) and counseling (OR 3.22, 95% CI 1.53, 6.77). Conclusions This study highlights the importance of ensuring stability with a USC. In our zeal to move people into new medical homes, we need to be wary of harming quality by disturbing existing care relationships, thus merely creating “temporary housing.”

Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health Care

“…24,25 An enduring relationship between the patient and his or her usual source of care also appears to be associated with better quality. 26 There is also evidence that patients with a "regular doctor" as a usual source of care, rather than a "regular practice site," are more likely to receive preventive services. 25,27,28 As compared to quality, the relationship between health outcomes and having a usual source of primary care has been less well studied.…”

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

“…We reported on cross-sectional measures for both insurance and a USC because we did not have data to capture longitudinal USC status; therefore, we could not capture the effects of duration of insurance and/or continuity with a USC. [55][56][57] We also did not account for the type of USC provider, which might contribute to subtle differences that were not measured in this study. 58 Also, we did not include a full analysis of the specific reasons people reported a lack of a USC; however, upon review of the main reasons we found the top reported to be that respondents were seldom or never sick and the second most common was that the cost of medical care was too high.…”

Parent and Child Usual Source of Care and Children's Receipt of Health Care Services

“…[1][2][3][4][5][6][7][8][9][10] Children with a USC have more consistent access to health care services, 2,9,[11][12][13][14][15] which likely contributes to better overall health outcomes. 16,17 According to recent estimates, however, approximately 19% of adults and nearly 10% of children in the United States do not have a USC.…”