Primary Care Appointment Availability and Preventive Care Utilization: Evidence From an Audit Study. (April 2015)

• Record Type: Journal Article
• Authors: Saloner, Brendan; Polsky, Daniel; Friedman, Ari; Rhodes, Karin
• Is Part Of: Medical care research and review. Volume 72:Number 2(2015:Apr.)
• Page Start: 149
• Page End: 167
• Publication Date: 2015-04
• Subjects: primary care -- access -- preventive care -- community effects -- audit study; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558715569541
• Languages: English
• ISSNs: 1077-5587

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.