Study: ER, Hospital Use Rises Alongside Trend Away from Personal Physician as Usual Source Care

FOR IMMEDIATE RELEASE: Friday, September 8, 2017

Contact:
Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224
lchampli@aafp.org 

WASHINGTON, DC — For more and more Americans, health care is provided at a place, not by a person, and the trend could be increasing the use of high-cost services, according to a study in Health Services Research. And where they get their care is linked to age and socio-economic factors.

The study, “Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All,” reported that over time, fewer people identified an individual doctor as their usual source of health care. Instead, more people said a place was their usual source of care. An increase in the number of emergency department visits and hospitalizations followed this trend.

Researcher Winston Liaw, MD, former medical director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and his colleagues conducted a trend analysis from the 1996-2014 Medical Expenditure Panel Survey data to learn whether respondents had a usual source of health care and whether regular care was provided by a health professional or a health facility.

They found that age, income, ethnicity and education level were associated with whether a person had a usual source of health care and whether that source of care was a specific health professional or a facility.

The data showed a growing percentage of people aged 18 to 34 did not have a usual source of health care. This group also were more likely to be uninsured, high school graduates and Hispanic. People who cited a facility such as a clinic as their usual source of care were more likely to be African-American and have incomes less than the federal poverty level, have Medicaid coverage, and have less than a high school education. People who earned more than 400 percent of the federal poverty level, had insurance, were White and had post-high school education were more likely to cite a specific health professional such as a physician as their usual source of care.

The findings are important to health care policy because the research confirmed previous studies demonstrating greater emergency and hospital use among people with no usual source of care. In Liaw’s study, people without a usual source of care were nearly 14 percent more likely to have an emergency department visit. He and his colleagues also found that people who cited a facility as their usual source of care were 12 percent more likely to have an emergency department visit.

“Similar findings were obtained using the hospitalization measure,” Liaw writes.

Despite the proven benefits of having a usual source of health care, the trend away from having a health professional and toward having a facility as their source of regular medical services is concerning, according to Liaw and his co-authors.

“The powerful, salutary effects of having a usual source of care have been documented for decades,” they conclude. “Despite these benefits, we found an increase in the percentage with no usual source of care and a drop in the percentage with person (as a) usual source of care and that these changes are associated with excess emergency department visits and hospital admissions. While this shift from clinicians to places may ultimately yield net positive effects, it also has the potential to degrade the relationships between patients and their clinicians that are foundational to proper health care.”

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About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.