A medical home versus temporary housing: the importance of a stable usual source of care.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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."
DeVoe
Jennifer E
JE
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. devoej@ohsu.edu
Saultz
John W
JW
Krois
Lisa
L
Tillotson
Carrie J
CJ
D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003266:Continuity of Patient Care; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health; D011320:Primary Health Care; D012959:Socioeconomic Factors; D013221:State Health Plans