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. 2000 Dec;90(12):1848–1855. doi: 10.2105/ajph.90.12.1848

Type of health insurance and the quality of primary care experience.

L Shi 1
PMCID: PMC1446448  PMID: 11111255

Abstract

OBJECTIVES: This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination. METHODS: The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than 65 years who identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while individual sociodemographic characteristics were controlled for. RESULTS: The experience of primary care varies according to insurance status. The insured are able to obtain better primary care than the uninsured, and the privately insured are able to obtain better primary care than the publicly insured. Those insured through fee-for-service coverage experience better longitudinal care and less of a barrier to access than those insured through health maintenance organizations (HMOs). CONCLUSIONS: While expanding insurance coverage is important for establishing access to care, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured. Policymakers should closely monitor the quality of primary care provided by HMOs.

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Selected References

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  1. Andersen R., Aday L. A. Access to medical care in the U.S.: realized and potential. Med Care. 1978 Jul;16(7):533–546. doi: 10.1097/00005650-197807000-00001. [DOI] [PubMed] [Google Scholar]
  2. Bindman A. B., Grumbach K., Osmond D., Vranizan K., Stewart A. L. Primary care and receipt of preventive services. J Gen Intern Med. 1996 May;11(5):269–276. doi: 10.1007/BF02598266. [DOI] [PubMed] [Google Scholar]
  3. Blendon R. J., Brodie M., Benson J. M., Altman D. E., Levitt L., Hoff T., Hugick L. Understanding the managed care backlash. Health Aff (Millwood) 1998 Jul-Aug;17(4):80–94. doi: 10.1377/hlthaff.17.4.80. [DOI] [PubMed] [Google Scholar]
  4. Davis K., Collins K. S., Schoen C., Morris C. Choice matters: enrollees' views of their health plans. Health Aff (Millwood) 1995 Summer;14(2):99–112. doi: 10.1377/hlthaff.14.2.99. [DOI] [PubMed] [Google Scholar]
  5. Flocke S. A. Measuring attributes of primary care: development of a new instrument. J Fam Pract. 1997 Jul;45(1):64–74. [PubMed] [Google Scholar]
  6. Flocke S. A., Stange K. C., Zyzanski S. J. The association of attributes of primary care with the delivery of clinical preventive services. Med Care. 1998 Aug;36(8 Suppl):AS21–AS30. doi: 10.1097/00005650-199808001-00004. [DOI] [PubMed] [Google Scholar]
  7. Freeman H. E., Corey C. R. Insurance status and access to health services among poor persons. Health Serv Res. 1993 Dec;28(5):531–541. [PMC free article] [PubMed] [Google Scholar]
  8. Freund D. A., Hurley R. E. Medicaid managed care: contribution to issues of health reform. Annu Rev Public Health. 1995;16:473–495. doi: 10.1146/annurev.pu.16.050195.002353. [DOI] [PubMed] [Google Scholar]
  9. Greenfield S., Rogers W., Mangotich M., Carney M. F., Tarlov A. R. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995 Nov 8;274(18):1436–1444. [PubMed] [Google Scholar]
  10. Hayward R. A., Bernard A. M., Freeman H. E., Corey C. R. Regular source of ambulatory care and access to health services. Am J Public Health. 1991 Apr;81(4):434–438. doi: 10.2105/ajph.81.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hellinger F. J. Selection bias in HMOs and PPOs: a review of the evidence. Inquiry. 1995 Summer;32(2):135–142. [PubMed] [Google Scholar]
  12. Hellinger F. J. The effect of managed care on quality: a review of recent evidence. Arch Intern Med. 1998 Apr 27;158(8):833–841. doi: 10.1001/archinte.158.8.833. [DOI] [PubMed] [Google Scholar]
  13. Kogan M. D., Alexander G. R., Teitelbaum M. A., Jack B. W., Kotelchuck M., Pappas G. The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States. JAMA. 1995 Nov 8;274(18):1429–1435. [PubMed] [Google Scholar]
  14. Lambrew J. M., DeFriese G. H., Carey T. S., Ricketts T. C., Biddle A. K. The effects of having a regular doctor on access to primary care. Med Care. 1996 Feb;34(2):138–151. doi: 10.1097/00005650-199602000-00006. [DOI] [PubMed] [Google Scholar]
  15. Lave J. R., Keane C. R., Lin C. J., Ricci E. M., Amersbach G., LaVallee C. P. Impact of a children's health insurance program on newly enrolled children. JAMA. 1998 Jun 10;279(22):1820–1825. doi: 10.1001/jama.279.22.1820. [DOI] [PubMed] [Google Scholar]
  16. Lieu T. A., Newman T. B. Issues in studying the effectiveness of health services for children. Health Serv Res. 1998 Oct;33(4 Pt 2):1041–1058. [PMC free article] [PubMed] [Google Scholar]
  17. Mechanic D. The orginization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings. Med Care. 1975 Mar;13(3):189–204. doi: 10.1097/00005650-197503000-00001. [DOI] [PubMed] [Google Scholar]
  18. Mueller K. J., Patil K., Boilesen E. The role of uninsurance and race in healthcare utilization by rural minorities. Health Serv Res. 1998 Aug;33(3 Pt 1):597–610. [PMC free article] [PubMed] [Google Scholar]
  19. Newacheck P. W., Stoddard J. J., Hughes D. C., Pearl M. Health insurance and access to primary care for children. N Engl J Med. 1998 Feb 19;338(8):513–519. doi: 10.1056/NEJM199802193380806. [DOI] [PubMed] [Google Scholar]
  20. Nutting P. A. Health promotion in primary medical care: problems and potential. Prev Med. 1986 Sep;15(5):537–548. doi: 10.1016/0091-7435(86)90029-0. [DOI] [PubMed] [Google Scholar]
  21. Safran D. G., Kosinski M., Tarlov A. R., Rogers W. H., Taira D. H., Lieberman N., Ware J. E. The Primary Care Assessment Survey: tests of data quality and measurement performance. Med Care. 1998 May;36(5):728–739. doi: 10.1097/00005650-199805000-00012. [DOI] [PubMed] [Google Scholar]
  22. Safran D. G., Taira D. A., Rogers W. H., Kosinski M., Ware J. E., Tarlov A. R. Linking primary care performance to outcomes of care. J Fam Pract. 1998 Sep;47(3):213–220. [PubMed] [Google Scholar]
  23. Safran D. G., Tarlov A. R., Rogers W. H. Primary care performance in fee-for-service and prepaid health care systems. Results from the Medical Outcomes Study. JAMA. 1994 May 25;271(20):1579–1586. [PubMed] [Google Scholar]
  24. Schoen C., Lyons B., Rowland D., Davis K., Puleo E. Insurance matters for low-income adults: results from a five-state survey. Health Aff (Millwood) 1997 Sep-Oct;16(5):163–171. doi: 10.1377/hlthaff.16.5.163. [DOI] [PubMed] [Google Scholar]
  25. Shi L. Primary care, specialty care, and life chances. Int J Health Serv. 1994;24(3):431–458. doi: 10.2190/BDUU-J0JD-BVEX-N90B. [DOI] [PubMed] [Google Scholar]
  26. Shi L. The relationship between primary care and life chances. J Health Care Poor Underserved. 1992 Fall;3(2):321–335. doi: 10.1353/hpu.2010.0460. [DOI] [PubMed] [Google Scholar]
  27. Smith W. G., Buesching D. Measures of primary medical care and patient characteristics. J Ambul Care Manage. 1986 Feb;9(1):49–57. doi: 10.1097/00004479-198602000-00006. [DOI] [PubMed] [Google Scholar]
  28. Sox C. M., Swartz K., Burstin H. R., Brennan T. A. Insurance or a regular physician: which is the most powerful predictor of health care? Am J Public Health. 1998 Mar;88(3):364–370. doi: 10.2105/ajph.88.3.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Starfield B., Cassady C., Nanda J., Forrest C. B., Berk R. Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. J Fam Pract. 1998 Mar;46(3):216–226. [PubMed] [Google Scholar]
  30. Starfield B. Is primary care essential? Lancet. 1994 Oct 22;344(8930):1129–1133. doi: 10.1016/s0140-6736(94)90634-3. [DOI] [PubMed] [Google Scholar]
  31. Temkin-Greener H., Winchell M. Medicaid beneficiaries under managed care: provider choice and satisfaction. Health Serv Res. 1991 Oct;26(4):509–529. [PMC free article] [PubMed] [Google Scholar]
  32. Terris M. Lean and mean: the quality of care in the era of managed care. J Public Health Policy. 1998;19(1):5–14. [PubMed] [Google Scholar]
  33. Wallack S. S. Managed care: practice, pitfalls, and potential. Health Care Financ Rev Annu Suppl. 1991:27–34. [PubMed] [Google Scholar]

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