Insurance Status Plays Key Role in Quality of Primary Care

Those carrying private insurance enjoy better primary care than those who are either publicly insured or not insured at all, according to researchers at the Johns Hopkins School of Public Health. Results of the study are published in the December 2000 issue of the American Journal of Public Health.

"The purpose of this study was to examine the association between the type of health insurance coverage and the quality of primary care. While the relationship between having health insurance and access to care is well known, few studies have examined the quality of primary care experienced by those with different insurance status," said lead author Leiyu Shi, DrPH, MBA, associate professor, Health Policy and Management, Johns Hopkins School of Public Health.

"Given the continuing trend toward a managed care system, it is important to monitor the quality of care so that the preoccupation with gate-keeping and cost containment is not at the expense of the quality of primary care," Dr. Shi added.

For this study, researchers used the Household Component (HC) of the 1996 Medical Expenditure Panel Survey (MEPS), a detailed collection of demographic characteristics; health conditions; health status; use of medical care services; charges and payments; access to primary care; satisfaction with care; health insurance coverage; income, and employment. The HC of MEPS is cosponsored by the Agency for Healthcare Research and Quality and by the National Center for Health Statistics.

Results of the study showed that the primary care experience varies according to one's insurance status. For example, of those who are insured, the privately insured received better primary care than the publicly insured because they were more likely to have an appointment rather than walking in. The privately insured also found it less difficult to make an appointment, had an easier time making phone contact with their usual source of care, and waited less during a visit. Those covered through Fee-for-Service insurance experienced better long-term care and less organizational restrictions than those insured through health maintenance organizations (HMOs).

After reviewing the results of the study, the researchers suggest more needs to be done to enhance the quality of primary health care, particularly for the publicly insured. Policy makers need to closely monitor the quality of primary care provision by HMOs.

This work was supported in part by funding from the Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services.