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

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.

Keywords: Disability; Provider continuity; Reason for no provider; Usual source of care.