Usual Source of Care in Preventive Service Use: A Regular Doctor versus a Regular Site

Abstract

Objective. To compare the effects of having a regular doctor and having a regular site on five preventive services, controlling for the endogeneity of having a usual source of care. Data Source. The Medical Expenditure Panel Survey 1996 conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. Study Design. Mammograms, pap smears, blood pressure checkups, cholesterol level checkups, and flu shots were examined. A modified behavioral model framework was presented, which controlled for the endogeneity of having a usual source of care. Based on this framework, a two-equation empirical model was established to predict the probabilities of having a regular doctor and having a regular site, and use of each type of preventive service. Principal Findings. Having a regular doctor was found to have a greater impact than having a regular site on discretional preventive services, such as blood pressure and cholesterol level checkups. No statistically significant differences were found between the effects a having a regular doctor and having a regular site on the use of flu shots, pap smears, and mammograms. Among the five preventive services, having a usual source of care had the greatest impact on cholesterol level checkups and pap smears. Conclusions. Promoting a stable physician-patient relationship can improve patients' timely receipt of clinical prevention. For certain preventive services, having a regular doctor is more effective than having a regular site.Key Words. Usual source of care, preventive services, endogeneity, behavioral model It has been well established that continuity of care is an important component of the quality of medical care (Starfield 1992). Lack of a usual source of care not only interrupts continuity of care but also imposes a significant barrier to receiving medical treatment. Having a usual source care is similar to having health insurance in the sense that both facilitate timely and adequate receipt of needed medical care (Baker, Stevens, and

When a Usual Source of Care and Usual Provider Matter: Adult Prevention and Screening Services

“…A study by Xu, using data from the national 1996 Medical Expenditure Panel Survey (MEPS), found that, for adults, having a usual doctor was more important than having a usual site of care for receipt of certain preventive services such as blood pressure and cholesterol level checks. 5 However, having a usual doctor had no more effect than having a usual site of care on the use of flu shots, pap smears, and mammograms. 5 Devoe et al, using the same data, found that receipt of preventive services was strongly associated with having insurance and having a usual provider for adults 18 years or older.…”

“…1 There is a growing body of research indicating that having a usual source of care improves timely access to medical care, improves quality of care received, and results in improved health status. 2,3,4,5 The…”

“…Fundamental to the development of the medical home concept will be to define and assess the required-or recommendedattributes of the medical home. Some of the key attributes of the "advanced" medical home include: (1) use of evidenced-based medicine, (2) use of the Chronic Care Model, (3) development of medical care plan in partnership with patients, (4) enhanced communication and access through telephone and e-mail, (5) use of health information technology, and (6) performance measurement. 6 It is not clear how many physician clinics currently meet these standards or if there is any empirical evidence to support the association between key attributes and improved health status or improved patient care outcomes.…”

Usual Source of Care and Outcomes Following Acute Myocardial Infarction

“…1 Approximately 85 % of Americans selfreport having a USOC, 2 which has been associated with higher quality care. 3,4 Having a USOC is associated with greater receipt of preventive services, 5,6 less use of emergency department visits, 7,8 and less engagement in risky behaviors. 9 Furthermore, a USOC is associated with improved management of chronic diseases such as HIV, 10 diabetes, 11 hypertension, 12 and hypercholesterolemia.…”

Income and Regional Gradients in Being without a Regular Doctor: Does the Slope of Gradients Decrease for Those with Greater Health Needs?

“…Having a regular doctor contributes to better continuity and improved patient satisfaction, improves the timeliness and comprehensiveness of preventive care, enhances adherence to treatment and averts inappropriate use of emergency departments for non-urgent conditions (Bindman et al 1996;Ettner 1999;Gill et al 2000;Hjortdahl and Laerum 1992;Schoen et al 2004). By ensuring continuity of care, having a primary care provider is also associated with better management of chronic disease, better population health, fewer physician visits and hospitalizations, lower medical costs during hospitalization and lower total healthcare costs (DeVoe et al 2003;Engstrom et al 2001;Gill and Mainous 1998;Lambrew et al 1996;McIsaac et al 2001;Saultz and Lochner 2005;Xu 2002). …”