A Medical Home Versus Temporary Housing: The Importance of a Stable Usual Source of Care

• Published in: Pediatrics (Evanston) Vol. 124; no. 5; pp. 1363 - 1371
• Main Authors: DeVoe, Jennifer E, Saultz, John W, Krois, Lisa, Tillotson, Carrie J
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-11-2009; American Academy of Pediatrics
• Subjects: Adolescent; Biological and medical sciences; Child; Child Health Services; Child, Preschool; Children & youth; Company business management; Comparative analysis; Continuity of Patient Care; Continuum of care; Estimates; General aspects; Government regulation; Health care; Health care services accessibility; Health insurance; Health Services Accessibility; Health Services Needs and Demand; Humans; Infant; Insurance Coverage; Insurance, Health; Laws, regulations and rules; Low income groups; Management; Medical sciences; Miscellaneous; Pediatrics; Primary Health Care; Public health. Hygiene; Public health. Hygiene-occupational medicine; Socioeconomic Factors; State Health Plans; United States; Oregon; United States > US; Human; Continuity of care; Health insurance; Pediatrics; Medical Home; access to health care; Accessibility; Primary health care; Specialized institution; Patient; Housing; Source; Temporary; continuity of patient care; Welfare aids; primary care; Child; Nursing home; delivery of health care; Comparative study; Public health
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2008-3141

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.
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.
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.
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."