Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2002 Jun;37(3):529-50.
doi: 10.1111/1475-6773.t01-1-00036.

Primary care, self-rated health, and reductions in social disparities in health

Leiyu Shi  1 , Barbara Starfield, Robert Politzer, Jerri Regan
Affiliations

Primary care, self-rated health, and reductions in social disparities in health

Leiyu Shi et al. Health Serv Res. 2002 Jun.

Abstract

Objective: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health.

Data sources: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care.

Study design: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States.

Data collection/extraction methods: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health.

Principal findings: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.

PubMed Disclaimer

References

    1. Bindman AB, Grumbach K, Osmond D. “Primary Care and Receipt of Preventive Services.”. Journal of General Internal Medicine. 1996;11:269–76. - PubMed
    1. Bunker J, Frazier H, Mosteller F. “Improving Health: Measuring the Effects of Medical Care.”. Milbank Quarterly. 1994;72(2):225–8. - PubMed
    1. Cassady C, Starfield B, Hurtado MP, Berk R, Nanda JP, Friedenberg LA. “Measuring Consumer Experiences with Primary Care.”. Journal of the Ambulatory Pediatric Association. 2000;105(4):998–1003. - PubMed
    1. Dievler A, Giovannini T. “Community Health Centers: Promises and Performance.”. Medical Care Research and Review. 1998;55:405–31. - PubMed
    1. Donaldson MS, Vanselow NA. “The Nature of Primary Care.”. Journal of Family Practice. 1996;42:113. - PubMed

Publication types