Dual eligibles without a usual source of care.

Gil, Preeti, and I recently published an article in the Disability and Health Journal about younger and older dually-eligible adults and their access to healthcare. One sub-analysis that we didn't have room to include was an examination of the reasons that respondents didn't have a usual source of care. I was surprised to see how many indicated that it was because they were "seldom or never sick" or because they "went different places for different needs." 

This stood out in the population of dual-eligibles, since so many have chronic and disabling conditions that "seldom or never sick" is not something I'd anticipate them saying about themselves. But of course, usual source of care is a form of potential access, not necessarily realized access, and not everyone agrees on its value.

I'd like to look more into this to be sure that those who are "voluntarily" without a usual source of care are making informed decisions. It's possible that they simply aren't aware of the benefits of care coordination, but it's also possible that they aren't able to find (or don't believe that they can find) a provider who can balance all of their competing health needs. It could also reflect that they are acting as their own care coordinators and/or have their health well-managed without the guidance of a single provider or clinic. (E.g., they have chronic and disabling conditions but also have good treatment options such that they are seldom or never "sick.")  If this is a voluntary difference rather than a externally-imposed disparity, then we should be careful interpreting lack of usual source of care as a negative situation in this population.