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Insurance or a regular physician: which is the most powerful predictor of health care?
C M Sox1, K Swartz, H R Burstin
1Department of Health Policy and Management, Harvard School of Public Health, Cambridge, Mass., USA.
Insights
Having a regular doctor is more important than insurance for accessing healthcare. Lacking a regular physician significantly impacts timely care and consistent health visits, highlighting the importance of continuous patient-physician relationships for better health outcomes.
Area of Science:
- Health Services Research
- Access to Care
- Physician-Patient Relationship
Background:
- Access to healthcare is a critical determinant of health outcomes.
- The roles of insurance status and a regular physician in facilitating healthcare access are debated.
- Understanding these factors is crucial for developing effective health policies.
Purpose of the Study:
- To compare the impact of having a regular physician versus insurance status on healthcare access.
- To identify which factor is a stronger predictor of delayed or missed care.
Main Methods:
- A study of 1952 non-Medicare adults (18-64 years) presenting to hospital emergency departments.
- Access to care was measured by delay in seeking care, and lack of physician or emergency department visits in the prior year.
- Statistical analyses controlled for clinical and socioeconomic characteristics.
Main Results:
- Lacking a regular physician was a stronger predictor of delayed care, no physician visit, and no emergency department visit compared to insurance status.
- Among patients with a regular physician, insurance status (uninsured vs. privately insured) did not affect access.
- Privately insured patients without a regular physician experienced worse access than those with a regular physician.
Conclusions:
- A consistent relationship with a regular physician is a more significant factor than insurance status in predicting access to care for emergency department patients.
- Establishing and maintaining a relationship with a regular physician may be key to improving healthcare access and continuity.
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.