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Am Fam Physician. 2000;62(3):477

Most people (82 percent) in the United States have and use for much of their health care a usual source of care, and a majority of them name a particular primary care physician as that source. Regardless of self-reported health status, people benefit from having a usual source of health care even if they are uninsured.

The Medical Expenditure Panel Survey (MEPS) is a national probability survey sponsored since 1996 by the Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research). As part of this survey, trained interviewers determine whether or not each individual in respondents' families has a usual source of health care. If so, the source is determined and characterized, and other data can be analyzed accordingly.

In 1996, 82 percent of Americans had a usual source for receiving health care. These individuals would go to this usual source for new health problems (97 percent) and preventive care (96 percent), and to seek referral for sub-specialty services (96 percent). Approximately 56 percent regarded an individual professional, rather than a facility, as their usual source of care. Of these providers, 62 percent identified a family physician, 16 percent a general internist and 15 percent a pediatrician, leaving all other provider types as the usual source of care for 8 percent.

Although there were virtually no differences in self-reported physical and mental health status comparing individuals with and without a usual source of care, profiles of use differed (see accompanying table).

Have usual source (%)No usual source (%)
Difficulty obtaining care1117
Went without needed services612
Doctor's office visit7539
Admitted to hospital84
Purchased any prescription medicine7038

Results from this survey also indicate that 17 percent of Americans were uninsured. Among the uninsured, a surprisingly high proportion (62 percent) could identify a usual source of health care. For 71 percent, a family physician was the usual source.

Inferences from MEPS data to the U.S. population, when weighted for survey design complexities, can be made with substantial confidence. For example, the estimate of 17 percent of Americans without insurance has a standard error of 0.47 percent.

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