Type of Health Insurance and the Quality of Primary Care Experience

Am J Public Health. 2000 Dec;90(12):1848-55. doi: 10.2105/ajph.90.12.1848.


Objectives: This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination.

Methods: The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than 65 years who identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while individual sociodemographic characteristics were controlled for.

Results: The experience of primary care varies according to insurance status. The insured are able to obtain better primary care than the uninsured, and the privately insured are able to obtain better primary care than the publicly insured. Those insured through fee-for-service coverage experience better longitudinal care and less of a barrier to access than those insured through health maintenance organizations (HMOs).

Conclusions: While expanding insurance coverage is important for establishing access to care, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured. Policymakers should closely monitor the quality of primary care provided by HMOs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Fee-for-Service Plans / standards*
  • Health Care Surveys
  • Health Maintenance Organizations / standards*
  • Health Services Accessibility / standards
  • Health Status
  • Humans
  • Insurance Coverage
  • Insurance, Physician Services / classification
  • Insurance, Physician Services / standards*
  • Logistic Models
  • Longitudinal Studies
  • Medically Uninsured / psychology*
  • Middle Aged
  • Patient Satisfaction*
  • Primary Health Care / standards*
  • Private Sector
  • Quality of Health Care*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • United States