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Effect of Usual Source of Care on Depression among Medicare Beneficiaries: An Application of a Simultaneous-Equations Model

Keywords: Access to care; health care use; usual source of care; depression; Medicare

Objective. To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.

Data Sources. The 20012003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.

Study Design. Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health? Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects.

Principal Findings. Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p=.03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p=.96).

Conclusions. USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries.

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