Brief Report
Provider continuity and reasons for not having a provider among persons with and without disabilities

https://doi.org/10.1016/j.dhjo.2018.09.002Get rights and content

Abstract

Background

Persons with disabilities experience health disparities while having usual providers more frequently than persons without disabilities. Provider discontinuity may help to explain these paradoxical findings, but research on the topic is nascent.

Objective

To provide initial insight into whether persons with disabilities more frequently experience provider discontinuity than persons without disabilities.

Methods

Pooled 2-year data from panels 14–16 (2009–2012) of the Medical Expenditure Panel Survey were examined. Working-age adults (18–64) were categorized as having no disability, basic disabilities, or complex disabilities. Persons were categorized having provider continuity (provider throughout the period) or discontinuity (gaining or losing providers during the period). χ2 and multinomial logistic regressions were used to examine outcomes by disability status.

Results

Persons with complex disabilities more frequently experienced continuity (83.7%) than persons without disabilities and those with basic disabilities (60.7% and 65.6%, respectively, p < 0.001). Seldom or never being sick was the most frequently reported reason for not having a usual provider; more persons without disabilities (64%) reported this reason than persons with disabilities (basic: 41.9%, p < 0.001; complex: 26.6%, p = 0.001). Persons with disabilities more frequently reported visiting different providers for different needs and not having a usual provider due to the costs of medical care than persons without disabilities.

Conclusions

Future research needs to examine the influence of continuity on healthcare disparities among persons with complex disabilities. Policies and practice must be attentive to how proposed changes to the healthcare system potentially reduce access to care among persons with disabilities.

Section snippets

Data source

The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of health and healthcare outcomes among non-institutionalized US civilians.26 New families enrolled in the MEPS each year constitute a panel of data; data on these panels are collected in 5 waves over a 2-year period on all persons in sampled families, resulting in an overlapping panel design that can be analyzed longitudinally or cross-sectionally.

Longitudinal data from Panels 14 (2009–2010), 15 (2010–2011), and

Results

Nearly 15% of the longitudinally weighted sample had a disability, including nearly 9% who reported a basic disability and 6% who reported a complex disability (Table 1). Persons with complex disabilities (83.7%) were significantly more likely to experience provider continuity than persons with basic and persons without disabilities (65.6% and 60.7% respectively, p < 0.001; Figure 1). Approximately 11% of persons with complex disabilities experienced discontinuity compared to 19% of persons

Discussion

Comparisons of provider (dis)continuity between persons with and without disabilities, over a 2-year period, among a nationally representative sample of working-age adults revealed that persons with complex disabilities were more likely to experience provider continuity than their peers without disabilities and with basic disabilities. Persons with disabilities more frequently reported care costs and going different places for different needs and less frequently reported never or seldom being

Conclusions

Persons with disabilities report having usual providers and experience provider continuity more frequently than persons without disabilities, yet, paradoxically, this advantage does not confer benefits for health and healthcare outcomes. Additional research is needed to further untangle these relationships. Policies and programs need to be sensitive to the health and healthcare needs, as well as the unique barriers to provider continuity, faced by persons with disabilities.

Funding

This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The authors have no conflict of interest.

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