title: Is change in global self-rated health associated with change in affiliation with a primary care provider? Findings from a longitudinal study from New Zealand.
abstract: OBJECTIVE
  To investigate the association of self-rated health and affiliation with a primary care provider (PCP) in New Zealand.
  
  
  METHODS
  We used data from a New Zealand panel study of 22,000 adults. The main exposure was self-rated health, and the main outcome measure was affiliation with a PCP. Fixed effects conditional logistic models were used to control for observed time-varying and unobserved time-invariant confounding.
  
  
  RESULTS
  In any given wave, the odds of being affiliated with a PCP were higher for those in good and fair/poor health relative to those in excellent health. While affiliation for Europeans increased as reported health declined, the odds of being affiliated were lower for Māori respondents reporting very good or good health relative to those in excellent health. No significant differences in the association by age or gender were observed.
  
  
  CONCLUSIONS
  Our data support the hypothesis that those in poorer health are more likely to be affiliated with a PCP. Variations in affiliation for Māori could arise for several reasons, including differences in care-seeking behaviour and perceived need of care. It may also mean that the message about the benefits of primary health care is not getting through equally to all population groups.
authors.affiliation: Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Victoria 3220, Australia. Electronic address: santosh.jatrana@otago.ac.nz.
authors.forename: Santosh
authors.initials: S
authors.lastname: Jatrana
authors.affiliation: Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand.
authors.forename: Ken
authors.initials: K
authors.lastname: Richardson
authors.affiliation: University of Otago, Dunedin, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Crampton
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D057566:Self Report; D017678:Sex Distribution; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Affiliation; Global self-rated health (SRH); New Zealand; Primary health care