Does managed care enable more low income persons to identify a usual source of care? Implications for access to care

BACKGROUND. By requiring or encouraging enrollees to obtain a usual source of care, managed care programs hope to improve access to care without incurring higher costs. OBJECTIVES. (1) TO examine the effects of managed care on the likelihood of low-income persons having a usual source of care and a usual physician, and; (2) To examine the association between usual source of care and access. RESEARCH DESIGN. Cross-sectional, survey of households conducted during 1996 and 1997. SUBJECTS, A nationally representative sample of 14,271 low-income persons. MEASURES. Usual source of care, usual physician, managed care enrollment, managed care penetration. RESULTS. High managed care penetration in the community is associated with a lower likelihood of having a usual source of care for uninsured persons (54.8% vs. 62.2% in low penetration areas) as well as a lower likelihood of having a usual physician (60% vs. 72.8%). Managed care has only marginal effects on the likelihood of having a usual source of care for privately insured and Medicaid beneficiaries. Having a usual physician substantially reduces unmet medical needs for the insured but less so for the uninsured. CONCLUSIONS. Having a usual physician can be an effective tool in improving access to care for low-income populations, although it is most effective when combined with insurance coverage. However, the effectiveness of managed care in linking more low-income persons to a medical home is uncertain, and may have unintended consequences for uninsured persons.