title: Insurance or a regular physician: which is the most powerful predictor of health care?
abstract: OBJECTIVE
  This study compared the relative effects on access to health care of relationship with a regular physician and insurance status.
  
  
  METHODS
  The subjects were 1952 nonretired, non-Medicare patients aged 18 to 64 years who presented with 1 of 6 chief complaints to 5 academic hospital emergency departments in Boston and Cambridge, Mass, during a 1-month study period in 1995. Access to care was evaluated by 3 measures: delay in seeking care for the current complaint, no physician visit in the previous year, and no emergency department visit in the previous year.
  
  
  RESULTS
  After clinical and socioeconomic characteristics were controlled, lacking a regular physician was a stronger, more consistent predictor than insurance status of delay in seeking care (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2, 2.1), no physician visit [OR] = 4.5%, 95% CI = 3.3, 6.1), and no emergency department visit (OR = 1.8, 95% CI = 1.4, 2.4). For patients with a regular physician, access was no different between the uninsured and the privately insured. For privately insured patients, those with no regular physician had worse access than those with a regular physician.
  
  
  CONCLUSIONS
  Among patients presenting to emergency departments, relationship with a regular physician is a stronger predictor than insurance status of access to care.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Cambridge, Mass., USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Sox
authors.forename: K
authors.initials: K
authors.lastname: Swartz
authors.forename: H R
authors.initials: HR
authors.lastname: Burstin
authors.forename: T A
authors.initials: TA
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*