Care Experiences Among Medicare Beneficiaries With and Without a Personal Physician

Published in: Medical Care, Volume 56, Issue 4 (April 2018), Pages 329-336

Posted on RAND.org on April 12, 2018

by Grant Martsolf, Marc N. Elliott, Amelia Haviland, Q. Burkhart, Nathan Orr, Sarah J. Gaillot, Debra Saliba

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Background

Having a "personal" physician is a critical element to care continuity. Little is known about which older adults are more likely to lack personal physicians and if their care experiences differ from those with a personal physician.

Objective

The objective of this study was to describe care experiences and characteristics associated with not having a personal physician.

Research Design

We compare rates of lacking a personal physician across subgroups. Using doubly robust propensity-score-weighted regression, we compare patient experience among beneficiaries with and without a personal physician.

Subjects

A total of 272,463 nationally representative beneficiaries age 65+ responding to the 2012 Medicare CAHPS survey.

Measures

Beneficiary characteristics, having a personal physician, 4 patient experience measures.

Results

Five percent of respondents reported no personal physician. Lacking a personal physician was more common for men, racial/ethnic minorities (eg, 16% of American Indian/Alaska Natives), and the younger and less educated. Those without a personal physician reported substantially poorer experiences on 4 measures (P<0.001); these differences are larger than those observed by key demographic characteristics. Beneficiaries without a personal physician were more than 3 times as likely to have not seen any health care provider in the last 6 months.

Conclusions

Even with the access provided by Medicare, a small but nontrivial proportion of seniors report having no personal physician. Those without a personal physician report substantially worse patient experiences and lacking a personal physician is more common for some vulnerable groups. This may underlie some previously observed disparities. Efforts should be made to encourage and help seniors without personal physicians to select one.

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