Is change in global self-rated health associated with change in affiliation with a primary care provider? Findings from a longitudinal study from New Zealand

摘要

Aims. To investigate the association of self-rated health and affiliation with a primary care provider (PCP) in New Zealand.Methods. We used data from a New Zealand panel study of 22,000 adults. The main exposure was self-rated health, and the main outcome measure was affiliation with a PCP. Fixed effects conditional logistic models were used to control for observed time-varying and unobserved time-invariant confounding.Results. In any given wave, the odds of being affiliated with a PCP were higher for those in good and fair/poor health relative to those in excellent health. While affiliation for Europeans increased as reported health declined, the odds of being affiliated were lower for Maori respondents reporting very good or good health relative to those in excellent health. No significant differences in the association by age or gender were observed.Conclusions. Our data support the hypothesis that those in poorer health are more likely to be affiliated with a PCP. Variations in affiliation for Maori could arise for several reasons, including differences in care-seeking behaviour and perceived need of care. It may also mean that the message about the benefits of primary health care is not getting through equally to all population groups.