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1 Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill, Chapel Hill, NC
2 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
3 Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
4 Department of Obstetrics/Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
CORRESPONDING AUTHOR: Anthony J. Viera, MD, Department of Family Medicine, 101 Manning Dr, CB 7595, UNC Chapel Hill, Chapel Hill, NC 27599, anthony_viera{at}med.unc.edu
PURPOSE We wanted to identify characteristics of adults who do not have a usual source of care and then stratify the analysis by those who prefer vs those who do not prefer to have a usual source of care.
METHODS We analyzed data from a nationally representative sample of 9,011 adults to identify characteristics of those more likely to not have a usual source of care. Based on stated reasons for lacking a usual source of care, we created 2 subpopulations of adults without a usual source of care: those who had no preference and those who did. We identified and compared characteristics of each subpopulation.
RESULTS In the year 2000, 20% of adults did not have a usual source of care. Among all adults, lack of insurance (odds ratio [OR] = 3.2; 95% confidence interval [CI], 2.6–3.9) was independently associated with lacking a usual source of care, as were male sex (OR = 2.1; 95% CI, 1.7–2.4), excellent reported health (OR = 2.0; 95% CI, 1.2–3.2), younger age (for ages 18–29 years, OR = 4.1; 95% CI, 3.1–5.4) and Hispanic ethnicity (OR = 1.5; 95% CI,1.2–1.9). Of those without a usual source of care, 72% cited reasons indicating no preference to have one. Associations among such respondents were similar to those found among adults as a whole. Among respondents who preferred to have a usual source of care, however, the sex of the respondent became less significant, lack of insurance became more significant, and reported health status became nonsignificant.
CONCLUSIONS Most adults who lack a usual source of care do so for reasons of preference, evidently placing little value on having a usual source of care. Helping these persons have a usual source of care will likely require different interventions than needed to help those who want a usual source of care but cannot get one.
Key Words: Health services accessibility • personal health services • usual source of care • delivery of health care • health services research
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