Regular source of care: Its impact on charges, hospitalizations and satisfaction among the elderly.

摘要

This study examined the influence having a regular source of medical care has on charges, avoidable hospitalizations, satisfaction and inpatient days among the elderly Medicare beneficiary population. Building on Aday and Andersen's access to care framework, this study sought to explain differences in health services utilization among the elderly that can be explained by the presence of a regular source of care, the site of that care, the speciality of the physician providing that care and the duration of the physician-patient relationship.;Using the 1991 Medicare Current Beneficiary Survey (MCBS) and attached claims files, the analysis answered two broad questions: (1) What is the relationship between having a regular source of care and the cost of care, satisfaction with care, avoidable hospitalizations, the mean number of inpatient days for this population, and the likelihood of having a problem and not seeing a doctor? (2) For those with a regular source of care, does the site of care, kind of doctor and the duration of the doctor-patient relationship influence the cost of care, satisfaction with care, avoidable hospitalizations and the mean number of inpatient days for this population?;Charges and inpatient days were modeled using two-part regression analysis. The first part, using logistic regression analysis, modeled the likelihood of having a charge or an inpatient day. The second part, using linear regression analysis, modeled the variability of charges or inpatient days. Satisfaction and the 'likelihood of having a problem and not seeing a doctor' were modeled using logistic regression analysis. Multivariate analysis of the relationship between avoidable hospitalizations and regular source of care was not performed because none of the control variables were significantly related to avoidable hospitalizations.;Having a regular source of care appears lo influence an elderly individuals ability to access the health care system. The logistic regression analyses indicated that elderly individuals with a regular source of care were more likely to have a total charge, physician charge and outpatient charge even after controlling for various enabling, predisposing and need characteristics. Additionally, elderly individuals with a regular source of care were less likely to have a problem and not see a doctor and were more likely to be satisfied with their medical care. However, having a regular source of care was not a significant predictor of having an inpatient charge or an inpatient day.;With the exception of inpatient charges and inpatient days, having a regular source of care explained some of the variability in charges amongst those with any resource use. The results of the linear regression analyses indicated that elderly individuals with a regular source of care had lower charges.;The effect of site of care, physician speciality and duration of the doctor-patient relationship on the outcome variables was minimal. The most decisive finding was that there is some relationship between the length of the doctor-patient relationship and charges. In general it appears as if patient charges decrease as the length of the doctor-patient relationship increases. (Abstract shortened by UMI.).