Changes in usual source of care and perceptions of health care access, quality, and use.

Abstract

We sought to evaluate the extent of changes in usual source of care and associations with perceived health care access, quality, and use. We collected cross-sectional data on adults from the 1998 to 1999 Community Tracking Household Survey (n = 48,720). Linear and logistic regressions accounted for survey design and possible confounders. Eleven percent of respondents reported a change in usual source of care in the last 12 months; 14% reported no usual source. After adjustment, respondents with a change in usual source reported more unmet needs than those with no usual source or a continuous usual source (13%, 10%, and 7%, respectively), whereas respondents with a change in usual source or no usual source reported lower satisfaction with health care than respondents with a continuous usual source (52%, 51%, and 68%, respectively). However, respondents with a change in usual source were more likely to see a physician in the last 12 months than those with no usual source or a continuous usual source (91%, 46%, and 83%, respectively). Persons who experience a change in usual source of care more closely resemble persons who have no usual source in perceptions of access and quality but resemble persons who have a continuous usual source in use. Although we cannot determine whether the change in usual source caused these variations in perceived access, quality, and use, these data suggest that there are important and unrecognized differences in interactions with the health system among individuals who report a usual source of care at a single point in time.