A Medical Home Versus Temporary Housing: The Importance of a Stable Usual Source of Care

Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA.
PEDIATRICS (Impact Factor: 5.3). 10/2009; 124(5):1363-71. DOI: 10.1542/peds.2008-3141
Source: PubMed

ABSTRACT Little is known about how the stability of a usual source of care (USC) affects access to care. We examined the prevalence of USC changes among low-income children and how these changes were associated with unmet health care need.
We conducted a cross-sectional survey of Oregon's food stamp program in 2005. We analyzed primary data from 2681 surveys and then weighted results to 84087 families, adjusting for oversampling and nonresponse. We then ascertained the percentage of children in the Oregon population who had ever changed a USC for insurance reasons, which characteristics were associated with USC change, and how USC change was associated with unmet need. We also conducted a posthoc analysis of data from the Medical Expenditure Panel Survey to confirm similarities between the Oregon sample and a comparable national sample.
Children without a USC in the Oregon population had greater odds of reporting an unmet health care need than those with a USC. This pattern was similar in national estimates. Among the Oregon sample, 23% had changed their USC because of insurance reasons, and 10% had no current USC. Compared with children with a stable USC, children who had changed their USC had greater odds of reporting unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need.
This study highlights the importance of ensuring stability with a USC. Moving low-income children into new medical homes could disturb existing USC relationships, thereby merely creating "temporary housing."

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose ‐ The purpose of this article is to identify enabling and inhibiting factors that influence patients during their consideration of medical tourism for their healthcare requirement. The research provides marketing and practice implications that help in promoting medical tourism service. Furthermore, the paper provides evidence from medical tourism service to establish the relationship between resource integration and adoption of the service. Design/methodology/approach ‐ The article takes a two-pronged exploratory study approach, with study one focusing on analysing prospective medical tourists' emotional impediments in their consideration of the service, while study two analyses the factors that helped medical tourists who have already availed the service, overcome the impediments. Findings ‐ In this article, it is identified that resource integration, particularly social resources, has a major impact on individual's decision to adopt a service. The exploratory study indicates that perceived knowledge disadvantage, lack of perceived control, and lack of social support in the destination country lead causes emotional discomfort to medical tourists. The study also indicates that the ability to integrate social resources available to them helped prospective medical tourists in their assessment of medical tourism service prior to adopting it. The article establishes that integration of social resources enables the patients to overcome the emotional discomfort and thus pursues to adopt medical tourism service. Originality/value ‐ While previous medical tourism service research has primarily focused on cognitive factors in patients' decision making such as quality and cost of healthcare services in destination countries, this article throws light on the enabling and inhibiting factors that influence adoption of medical tourism service.
    International Journal of Quality and Service Sciences 08/2013; 5(3). DOI:10.1108/IJQSS-07-2012-0005
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (≥3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.
    Journal of the Korean Medical Association 01/2012; 55(2):187. DOI:10.5124/jkma.2012.55.2.187 · 0.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite considerable potential for improving health care quality, adoption of new technologies, such as electronic medical records (EMRs), requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients' perceptions of health care provider use of EMRs and health care quality ratings was assessed. Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390). All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted. EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of care quality (Beta=4.83, standard error [SE]=1.7, P<0.01), controlling for sociodemographic characteristics, usual source of health care, and health insurance status. Nationally representative data suggest that patients' perceptions of EMR use are associated with their perceptions of the quality of the health care they receive.
    Patient Related Outcome Measures 01/2014; 5:17-23. DOI:10.2147/PROM.S58967


Available from