title: Primary care appointment availability and preventive care utilization: evidence from an audit study.
abstract: Insurance expansions under the Affordable Care Act raise concerns about primary care access in communities with large numbers of newly insured. We linked individual-level, cross-sectional data on adult preventive care utilization from the 2011-2012 Behavioral Risk Factor Surveillance System to novel county-level measures of primary care appointment availability collected from an experimental audit study conducted in 10 states in 2012 to 2013 and other county-level health service and demographic measures. In multivariate regressions, we found higher county-level appointment availability for privately insured adults was associated with significantly lower preventive care utilization among adults likely to have private insurance. Estimates were attenuated after controlling for county-level uninsurance, poverty, and unemployment. By contrast, greater availability of Medicaid appointments was associated with higher, but not statistically significant, preventive care utilization for likely Medicaid enrollees. Our study highlights that the relationship between preventive care utilization and primary care access in small areas likely differs by insurance status.
authors: Johns Hopkins University, Baltimore, MD, USA bsaloner@gmail.com.
authors: Brendan
authors: B
authors: Saloner
authors: University of Pennsylvania, Philadelphia, PA, USA.
authors: Daniel
authors: D
authors: Polsky
authors: University of Pennsylvania, Philadelphia, PA, USA.
authors: Ari
authors: A
authors: Friedman
authors: University of Pennsylvania, Philadelphia, PA, USA.
authors: Karin
authors: K
authors: Rhodes
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: access; audit study; community effects; preventive care; primary care