Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model

Health Serv Res. 2011 Aug;46(4):1059-81. doi: 10.1111/j.1475-6773.2011.01240.x. Epub 2011 Feb 9.


Objective: To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.

Data sources: The 2001-2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.

Study design: Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question "Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health?" Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects.

Principal findings: Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p=.03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p=.96).

Conclusions: USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Depression / diagnosis*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Research / statistics & numerical data
  • Health Status
  • Humans
  • Male
  • Medicare Part A / statistics & numerical data*
  • Medicare Part B / statistics & numerical data*
  • Patient-Centered Care / statistics & numerical data*
  • Sex Factors
  • Socioeconomic Factors
  • United States