A Usual Source of Care

Abstract

Objectives-To examine the separate and combined effects of having health insurance and a usual source of care (USC) on access to healthcare for low-income children and to determine if one or the other is superior in ensuring better access to necessary services.Methods-We conducted cross-sectional, multivariable analyses of data from a mail-return survey of Oregon's food stamp program. Results from 2681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling techniques and nonresponse.Results-Among low-income Oregon children, those with health insurance and a USC reported the best access to healthcare. In multivariable comparisons to this reference group, insured children without a USC had higher rates of unmet medical need [odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.27-3.73]; no doctor visits in 12 months (OR = 6.77; 95% CI: 3.80-12.06); and problems obtaining specialty care (OR = 4.12; 95% CI: 1.59-10.68). Similarly, having a USC but not health insurance was associated with an even higher likelihood of unmet medical needs (OR = 4.33; 95% CI: 2.85-6.57); as well as unmet prescription needs (OR = 2.64, 95% CI: 1.77-3.94), and problems obtaining dental care (OR = 4.83;).Conclusions-Incremental policy solutions are being proposed that focus on either health insurance coverage for children or expanded access to primary care. However, neither approach displaces the need for the other. The effects of a USC and health insurance, together, are additive predictors of the likelihood that children have optimal access to necessary healthcare services.

Medical Home Disparities Between Children With Public and Private Insurance

“…23, 24 Most medical home research involving children with public insurance has focused instead on potential access, typically measured as a usual source of care. 23–26 By that measure, nearly all children with public and private insurance in this study would have a medical home. In contrast, disparities by insurance type in this study are apparent in markers of realized access, including a process of care (getting needed referrals) and the experience of care (family-centered care).…”

“…23–26 As described in the Behavioral Model of Health Services Use by Andersen and Aday, realized access is defined as rates of utilization and subjective descriptions of care, in contrast to potential access, which is defined as facilitators of care such as insurance and a usual source of care. 23, 24 These studies have primarily measured the medical home as a usual source of care, 23–26 despite the growing use of measures that address many other attributes of the medical home. 7, 10, 11, 27, 28 No studies to date have compared the prevalence of multiple components of the medical home (i.e., realized access) for children with public versus private insurance.…”

Understanding how low-income families prioritize elements of health care access for their children via the optimal care model

“…Participants in this study described how health care providers helped them overcome access barriers to receive needed care. Previous research has also recognized the importance of established relationships with trusted health care providers to mitigate barriers [ 30 – 35 ]. We organized the concepts described to us into a new conceptual model called the Optimal Care Model (Figure 1 ).…”

Access to health services among sexual minority people in the United States

“…Access to health insurance is associated with timely health service use and a reduction of chronic health conditions (Institute of Medicine, 1993; Lyon et al, 2014). A usual place of care to receive primary care services (which does not include emergency or hospital in‐patient services) helps gain access to timely medical treatment or preventative health services (Devoe et al, 2008; Shi, 2012), while culturally appropriate health services address the experiences and concerns unique to specific populations (Healthy People, 2020).…”