4141.0: Tuesday, November 14, 2000 - 12:30 PM

Abstract #2366

Type of Health Insurance Coverage and Quality of Primary Care

Leiyu Shi, DrPH, MBA, Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Room 409, Baltimore, MD 21212, 410-614-6507, lshi@jhsph.edu

Study Objectives. This study examined the association between the type of health insurance coverage and the quality of primary care as measured by its distinguishing attributes, i.e., first contact, longitudinality, comprehensiveness, and coordination, and achieved by a nationally representative population with particular emphasis on vulnerable sub-populations.

Methods. The Household Component of the 1996 Medical Expenditure Panel Survey (MEPS) was used for this study. The analysis primarily focused on the under-65 subjects that have identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while controlling for individual sociodemographic characteristics. A new framework of vulnerable populations is used to define vulnerability that focuses on the convergence of predisposing, enabling, and need attributes of risk.

Results. The experience of primary care varies according to one's insurance status. The insured are able to receive better primary care than the uninsured and the privately insured than the publicly insured. FFS insured experience better longitudinal care and less organizational aspect of the access barrier than HMO insured. Individuals with multiple vulnerable traits experience worse primary care controlling for the effect of insurance.

Conclusions. While expanding insurance coverage is important to establish access, efforts are needed to enhance the quality of primary health care particularly for the publicly insured and those with a convergence of vulnerable traits. Policy makers should closely monitor the quality of primary care provision by HMOs particularly for vulnerable sub-populations.

Learning Objectives: Become knowledgeable of the quality of primary care achieved by the nation's vulnerable populations. Assess the relationship between type of health insurance coverage and the quality of primary care

Keywords: Access and Services,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA