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      The Oregon experiment re-examined: the need to bolster primary care

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          Abstract

          John Heintzman and colleagues use less publicized evidence from Oregon to argue that unless access to primary care is improved, the benefits of widening the eligibility for public health insurance on individual and population health will be limited

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          The medical home, access to care, and insurance: a review of evidence.

          Barbara Starfield, Leiyu Shi (2004)
          To review the extent to which the literature supports the position that a medical home is important and to review the extent to which insurance is related to having a medical home. A review of literature concerning the benefits of a medical home on effectiveness, costs, and equity (reducing disparities) was conducted. International and within-nation studies indicate that a relationship with a medical home is associated with better health, on both the individual and population levels, with lower overall costs of care and with reductions in disparities in health between socially disadvantaged subpopulations and more socially advantaged populations. Although important in facilitating use overall, insurance does not guarantee a medical home. A medical home, with its 4 key features, provides better effectiveness as well as more efficient and more equitable care to individuals and populations. A concerted attempt to provide a means of universal financial access as well as a medical home should be of high priority for the United States.
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            Preventable hospitalizations in primary care shortage areas. An analysis of vulnerable Medicare beneficiaries.

            M L Parchman, S D Culler (2015)
            Health care outcomes among vulnerable elderly populations (defined in this study as Medicare beneficiaries who rated their overall general health as "fair" or "poor") are a growing concern. Recent studies suggest that potentially preventable hospitalizations may be useful for identifying poor ambulatory health care outcomes among vulnerable populations. To determine if Medicare beneficiaries in fair or poor health are at increased risk of experiencing a preventable hospitalization if they reside in primary care health professional shortage areas. A survey of Medicare beneficiaries from the 1991 Medicare Current Beneficiary Survey. Medicare beneficiaries living in the community. Medicare beneficiaries in fair or poor health were 1.82 times more likely to experience a preventable hospitalization if they resided in a primary care shortage area (95% confidence interval, 1.18-2.81). After controlling for educational level, income, and supplemental insurance, Medicare beneficiaries in fair or poor health were 1.70 times more likely to experience a preventable hospitalization if they resided in a primary care shortage area (95% confidence interval, 1.09-2.65). Medicare beneficiaries in fair or poor health are more likely to experience a potentially preventable hospitalization if they live in a county designated as a primary care shortage area. Provision of Medicare coverage alone may not be enough to prevent poor ambulatory health care outcomes such as preventable hospitalizations. Improving health care outcomes for vulnerable elderly patients may require structural changes to the primary care ambulatory delivery system in the United States, especially in designated shortage areas.
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              Usual Source of Care as a Health Insurance Substitute for U.S. Adults With Diabetes?

              Jennifer E DeVoe, Carrie Tillotson, Lorraine Wallace (2009)
              OBJECTIVE The purpose of this study was to examine the effects of health insurance and/or a usual source of care (USC) on receipt of diabetic-specific services and health care barriers for U.S. adults with diabetes. RESEARCH DESIGN AND METHODS Secondary analyses of data from 6,562 diabetic individuals aged ≥18 years from the nationally representative Medical Expenditure Panel Survey from 2002 to 2005 were performed. Outcome measures included receipt of seven diabetic services plus five barriers to care. RESULTS More than 84% of diabetic individuals in the U.S. had full-year coverage and a USC; 2.3% had neither one. In multivariate analyses, the uninsured with no USC had one-fifth the odds of receiving A1C screening (odds ratio 0.23 [95% CI 0.14–0.38]) and one-tenth the odds of a blood pressure check (0.08 [0.05–0.15]), compared with insured diabetic individuals with a USC. Similarly, being uninsured without a USC was associated with 5.5 times the likelihood of unmet medical needs (5.51 [3.49–8.70]) and three times more delayed urgent care (3.13 [1.53–6.38]) compared with being insured with a USC. Among the two groups with either insurance or a USC, diabetic individuals with only a USC had rates of diabetes-specific care more similar to those of insured individuals with a USC. In contrast, those with only insurance were closer to the reference group with fewer barriers to care. CONCLUSIONS Insured diabetic individuals with a USC were better off than those with only a USC, only insurance, or neither one. Policy reforms must target both the financing and the delivery systems to achieve increased receipt of diabetes services and decreased barriers to care.
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                Author and article information

                Contributors
                John Heintzman: Role: assistant professor
                Rachel Gold: Role: investigator
                Steffani R Bailey: Role: assistant research professor
                Jennifer E DeVoe: Role: chief research officer
                Journal
                Journal ID (nlm-ta): BMJ
                Journal ID (iso-abbrev): BMJ
                Journal ID (publisher-id): bmj
                Title: BMJ : British Medical Journal
                Publisher: BMJ Publishing Group Ltd.
                ISSN (Print): 0959-8138
                ISSN (Electronic): 1756-1833
                Publication date Collection: 2014
                Publication date (Electronic): 20 October 2014
                Volume: 349
                Electronic Location Identifier: g5976
                Affiliations
                [1 ]Oregon Health and Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
                [2 ]Kaiser Center for Health Research, Portland, Oregon, USA
                [3 ]OCHIN, Portland, Oregon, USA
                Author notes
                Correspondence to: J Heintzman heintzma@ 123456ohsu.edu
                Article
                Publisher ID: heij021263
                DOI: 10.1136/bmj.g5976
                PMC ID: 4707713
                PubMed ID: 25331018
                SO-VID: 4ca1fb68-4ca8-4598-af9a-d7ebf34db319
                Copyright © © BMJ Publishing Group Ltd 2014
                History
                Date accepted : 22 September 2014
                Categories
                Subject: Analysis
                Subject: 1779

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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