ACCESS: Regular Doctor, Not Coverage, Is More Significant

      A study in this month's issue of the American Journal of Public Health concludes that having a regular physician is a stronger predictor than having insurance coverage of whether a person has adequate access to health care. Researchers at Harvard School of Public Health found that "[p]atients with no regular physician were significantly more likely than those with a regular physician to delay seeking care (36.2% vs. 27%) and to report no physician visits in the last year (39.5% vs. 9.3%) and no emergency department visits in the last year (62% vs. 51%)." For the three measures, the researchers noted that "[l]ack of a regular physician was the only explanatory variable that was a statistically significant predictor." They found that even "[a]mong privately insured patients, those with no regular physician had worse access than those with a regular physician." Further, for patients who did have a regular doctor, the researchers "detected no difference in access between privately insured patients and either uninsured patients or Medicaid recipients." The findings were based on interviews with 1,952 patients treated at five academic hospital emergency rooms in the Boston area.

The Obvious Implication
      Based on their findings, the researchers write that "[c]are delivery programs that direct each patient to choose a regular physician may reduce barriers to access, potentially even in patient populations with traditionally poor access to care." Having a regular doctor, they note, can help patients "negotiate the health care system and ... make decisions about when they should pursue care." The researchers also note the explicit relationship between having coverage and having a regular doctor: 65% of uninsured patients in the study "had no regular physician, compared with 20.8% of privately insured patients and 18.8% of Medicaid patients" (Sox et al, 3/98 issue).