Privately Insured Receive Better Primary Care than Publicly Insured or Uninsured, Study Finds

Patients with insurance experience better primary care than the uninsured, and those with private insurance have better primary care than those with public insurance, reports a study in the American Journal of Public Health. Using the "household component" of the 1996 Medical Expenditure Panel Survey (MEPS), conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics, Johns Hopkins health policy Assoc. Prof. Leiyu Shi measured "primary care attributes" and insurance status for 20,469 people under age 65. Primary care attributes included whether the person had a "usual source of care" (USC), whether the person had appointments or walked in to see the USC, and whether the person visited the USC for preventive health care. Respondents were divided into four groups based on insurance status: private HMO, private fee-for-service, public insurance (primarily Medicaid) and no insurance.

Results
The study found that patients with insurance were 3.4 times more likely to have a USC than uninsured patients, and 0.74 times more likely to identify that USC as a person rather than a facility. Insured patients were 1.38 times more likely to have an appointment to see their USC, 1.39 times more likely to go to the USC for preventive care, experienced less difficulty in reaching their USC by phone and had shorter waits during visits. In addition, the insured were 2.63 times more likely to be "very satisfied that their family could get care" than the uninsured. Comparing those with private insurance to those with public insurance, the study found that the privately insured were "more likely ... to receive better first-contact care," explaining that first contact "implied access to and use of services for each new problem for which people seek health care." The privately insured also were more likely to have a person rather than a facility as their USC, found it easier to get appointments or to contact their USC by phone and experienced shorter waits, and were 1.63 times more likely than the publicly insured to be very satisfied with their family's access to care. However, insurance type did not appear to affect the "comprehensiveness" of care received. In his discussion of the results, Shi noted the findings imply the existence of a "two-tiered system, with one tier for the well-financed privately insured and another tier for the poorly financed publicly insured." He added, "These findings indicate that although expanding insurance coverage is important for improving access, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured" (Shi, American Journal of Public Health, 12/2000).