Insurance or a regular physician: which is the most powerful predictor of health care?

Abstract

OBJECTIVES: This study compared the relative effects on access to health care of relationship with a regular physician and insurance status. METHODS: The subjects were 1952 nonretired, non-Medicare patients aged 18 to 64 years who presented with 1 of 6 chief complaints to 5 academic hospital emergency departments in Boston and Cambridge, Mass, during a 1-month study period in 1995. Access to care was evaluated by 3 measures: delay in seeking care for the current complaint, no physician visit in the previous year, and no emergency department visit in the previous year. RESULTS: After clinical and socioeconomic characteristics were controlled, lacking a regular physician was a stronger, more consistent predictor than insurance status of delay in seeking care (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2, 2.1), no physician visit [OR] = 4.5%, 95% CI = 3.3, 6.1), and no emergency department visit (OR = 1.8, 95% CI = 1.4, 2.4). For patients with a regular physician, access was no different between the uninsured and the privately insured. For privately insured patients, those with no regular physician had worse access than those with a regular physician. CONCLUSIONS: Among patients presenting to emergency departments, relationship with a regular physician is a stronger predictor than insurance status of access to care.

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

“…For example, a clinical network to provide care pathways for aboriginal and Torres Straights populations with acute coronary syndromes, 227 a model of a trauma network in the USA 228 and, perhaps more relevant, a network for integrating ambulance services and acute hospitals in the Netherlands. 229 The description for this network included a statement that government policy had been put in place to monitor development, but no outputs have been identified.…”

Health Care Utilization Among Drug-Using and Non-Drug-Using Women

“…42 Studies have documented communication problems between physicians and patients who are of low socioeconomic status, older, and African American. 9,27 This is disheartening, especially if the relationship with a regular physician has a profound influence on access to care 28 and the potential for preventive health information relative to emergency rooms. 16 Traditional norms and experiences of interaction with physicians are likely to influence the use of care for older women, as well as for drug-using women.…”

“…5,13,16,17 Determinants of health, the need for health care, and access to care all have been shown to differ according to age, gender, racial or ethnic background, socio-economic status, geographic location, and various enabling conditions. [18][19][20][21][22][23][24][25][26][27][28] In this article, we address those factors that have traditionally been associated with health care utilization in previous studies, but also examine the independent and interrelated contribution of age and drug use to utilization of services among a group of potentially underserved women. Given the high and possibly increasing mortality rate among many drug users, 29 often coupled with a high prevalence of unemployment, poor education, AIDS, criminal behavior, mental illness, and inadequate social support, 13,21,22 one would assume that many chronic drug users may be in the greatest need of care due to direct and indirect consequences of drug use.…”

“…5,[7][8][9]18 Despite the many steps taken to reduce disparities, financial barriers and socioeconomic factors continue to have an impact on preventive health care and access to care among vulnerable populations. [18][19][20]28 Age differences in factors associated with health care and health care utilization have been demonstrated, but vary greatly depending on the particular health service examined and categorization of age groups. Even patient attitudes toward care have been shown to differ by age.…”

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

“…The few studies that have combined the two predictors have usually focused exclusively on a single outcome or a specific population. [21][22][23][24][25] The primary objectives of this study were (1) to describe the prevalence of and characteristics associated with having insurance coverage and/or a USC; and (2) to ascertain the separate and combined association between having health insurance and/or a USC and self-reported access to health care services for a nationally representative population of adults who reported having a need for services.…”