title: The case for synergy between a usual source of care and health insurance coverage.
abstract: BACKGROUND
  In 2010, the United States (US) passed health insurance reforms aimed at expanding coverage to the uninsured. Yet, disparities persist in access to health care services, even among the insured.
  
  
  OBJECTIVE
  To examine the separate and combined association between having health insurance and/or a usual source of care (USC) and self-reported receipt of health care services.
  
  
  METHODS
  Two-tailed, chi-square analyses and logistic regression models were used to analyze nationally representative pooled 2002-2007 data from the Medical Expenditure Panel Survey (MEPS).
  
  
  METHODS
  US adults (≥18 years of age) in the MEPS population who had at least one health care visit and who needed any care, tests, or treatment in the past year (n = 62,067).
  
  
  METHODS
  We assessed the likelihood of an adult reporting unmet medical needs; unmet prescription needs; a problem getting care, tests, or treatment; and delayed care based on whether each individual had health insurance, a USC, both, or neither one.
  
  
  RESULTS
  Among adults who reported a doctor visit and a need for services in the past year, having both health insurance and a USC was associated with the lowest percentage of unmet medical needs, problems and delays in getting care while having neither one was associated with the highest unmet medical needs, problems and delays in care. After adjusting for potentially confounding covariates (age, race, ethnicity, employment, geographic residence, education, household income as a percent of federal poverty level, health status, and marital status), compared with insured adults who also had a USC, insured adults without a USC were more likely to have problems getting care, tests or treatment (adjusted relative risk [aRR] 1.27; 95% confidence interval [CI] 1.18-1.37); and also had a higher likelihood of experiencing a delay in urgent care (aRR 1.12; 95% CI 1.05-1.20).
  
  
  CONCLUSIONS
  Amidst ongoing health care reform, these findings suggest the important role that both health insurance coverage and a usual source of care may play in facilitating individuals' access to care.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA. devoej@ohsu.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lesko
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies / Q000379:methods; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods* / Q000639:trends; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D007348:Insurance, Health / Q000191:economics / Q000639:trends*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055815:Young Adult