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

Authors

  • Chunyu Li,

    1. Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, 4770 Buford Hwy NE, Mailstop K-55, Atlanta, GA
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    • Address correspondence to Chunyu Li, M.D., Ph.D., Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, 4770 Buford Hwy NE, Mailstop K-55, Atlanta, GA 30341-3717; e-mail: chunyu.li@cdc.hhs.gov. Bruce Friedman, Ph.D., Associate Professor, is with the Department of Community and Preventive Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY. Andrew W. Dick, Ph.D., Senior Economist, is with the The RAND Corporation, Boston, MA. Kevin Fiscella, M.D., M.P.H., Associate Professor, is with the Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY. Yeates Conwell, M.D., Professor, is with the Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY.

  • Andrew W. Dick,

    1. Senior Economist, is with the The RAND Corporation, Boston, MA
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  • Kevin Fiscella,

    1. Associate Professor, is with the Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
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  • Yeates Conwell,

    1. Professor, is with the Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY
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  • Bruce Friedman

    1. Associate Professor, is with the Department of Community and Preventive Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
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Abstract

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

Data Sources. The 2001–2003 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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