Adults’ Lack of a Usual Source of Care: A Matter of Preference?

Anthony J. Viera; Donald E. Pathman; Joanne M. Garrett

doi:10.1370/afm.557

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Usual Source of Care Offers Convenience and Continuity
Anthony J. Viera

Published on: 28 August 2006
Usual source of care and interpersonal continuity
John W. Saultz

Published on: 15 August 2006

Published on: (28 August 2006)
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Usual Source of Care Offers Convenience and Continuity
Anthony J. Viera, Chapel Hill, USA
Other Contributors:
We thank Dr. Saultz for his letter and believe he has identified exactly the issue we find important from our study. Most people who do not have a usual source of care simply don’t want one or don’t want one enough to bother obtaining one. The most provocative policy question is whether having a usual source of care should be mandated in some fashion. As Dr. Saultz points out, without a publicly mandated program immunizati...
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We thank Dr. Saultz for his letter and believe he has identified exactly the issue we find important from our study. Most people who do not have a usual source of care simply don’t want one or don’t want one enough to bother obtaining one. The most provocative policy question is whether having a usual source of care should be mandated in some fashion. As Dr. Saultz points out, without a publicly mandated program immunizations would never have become near-universal and thereby had their enormous impact on public health. Left to their preferences, many people would choose not to be immunized. But should a similar public health and paternalistic approach be taken to assure that every American has a medical home? Perhaps the answer depends on whether society views health care as largely a “consumer product” to be bought at the buyer’s discretion or something more.
The fact that 3.3% of adults say they lack a usual source of care because they go to different places for different needs suggests that one place (or one health care provider) is just as good as another to many people.1 “Consumers” of health care often favor convenience over continuity. Part of the solution to medical homelessness, therefore, lies in improving the convenience of care provided by continuity physicians’ offices. We believe that a usual source of care can offer valuable continuity and convenience, but for having a usual source of care to become more universal, more people must learn of the value of continuity of care, and more doctors must recognize the barriers to continuity they create through the inconveniences their offices pose for patients. While there remain several challenges in improving America’s health, we believe educational interventions regarding the importance of having a usual source of care are a reasonable place to start.
Anthony J. Viera, MD MPH, Donald E. Pathman, MD MPH, University of North Carolina, Department of Family Medicine
1Viera AJ, Pathman DE, Garrett JM. Adults’ lack of a usual source of care: a matter of preference? Ann Fam Med 2006;4:359-65.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (15 August 2006)
Page navigation anchor for Usual source of care and interpersonal continuity
Usual source of care and interpersonal continuity
John W. Saultz, Portland, Oregon
I found the paper by Viera and colleagues to be an interesting addition to our literature about continuity of care. I doubt that many family physicians are surprised to learn that many, if not most, of those without a usual source of care choose not to have one. This finding correlates well with research that has shown that older and sicker people are more likely to have continuity with their primary provider. There a...
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I found the paper by Viera and colleagues to be an interesting addition to our literature about continuity of care. I doubt that many family physicians are surprised to learn that many, if not most, of those without a usual source of care choose not to have one. This finding correlates well with research that has shown that older and sicker people are more likely to have continuity with their primary provider. There are also convincing data that certain desirable aspects of primary and preventive care occur more often in those with a usual source of care. What we don't know is whether giving a usual source of care to people who don't want one will improve their health or harm them.
But imagine what an odd question this is! In America today, market driven health care is the ruling paradigm. Is our primary purpose to serve consumer demand or to care for patients' needs? How ofen are these the same thing and how often are they different? Surely people benefit from immunizations whether or not they want them? Is having a usual sopurce of care like this as well? Maybe we still have a lot to learn about what aspects of continuity of care really create measurable benefit for people before we try to desgn such a system for everyone? This study is a nice step in the direction of understanding this better.
Competing interests: None declared
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Competing Interests: None declared.