Dedicated Health Care Provider - Age 65+ in Hawaii

Hawaii

Individuals with a dedicated health care provider are better positioned to receive care that can prevent, detect and manage health conditions. Having a regular health care provider helps patients and providers build stable, long-term relationships that are associated with several benefits, including:

• Improved preventive care.
• Improved chronic care management for conditions such as high blood pressure and high cholesterol.
• Fewer emergency department visits for non-urgent or avoidable problems.
• Reduced mortality.

Older adults face several obstacles to obtaining the care they need, including transitioning from employer-sponsored health care to Medicare, traveling long distances (especially for those in rural areas) and high out-of-pocket costs.

According to America’s Health Rankings analysis, the percentage of older adults with a dedicated health care provider is higher among: 

• Women compared with men.
• Hawaiian/Pacific Islander, white and multiracial adults compared with Hispanic adults.
• Those with higher levels of education compared with those with less than a high school education.
• Those with higher levels of income compared with those with an annual household income less than $25,000.
• Straight adults compared with LGBQ+ adults.

Strategies for increasing the prevalence of adults with a dedicated health care provider include:

• Increasing primary care capacity by empowering licensed personnel, including nurse practitioners and physician assistants, to provide more care, particularly in regions with health care workforce shortages. This can be done by enacting scope-of-practice laws that enable nurse practitioners to perform more primary care functions. Scope-of-practice laws lead to increases in the number of nurse practitioners per capita and higher yearly growth of the nurse practitioner workforce. 
• Reorienting health care systems to encourage patients to use primary care for new symptoms instead of seeking specialists with low-impact and high-cost procedures.
• Addressing care gaps for those without health insurance, high cost of care, poor geographic availability of services and language barriers.

The Centers for Medicare & Medicaid Services provides a list of Medicare-enrolled physicians and health care professionals by region that can be used to find local providers.

Increasing the proportion of individuals of all ages with a usual primary care provider is a Healthy People 2030 leading health indicator.

Blewett, Lynn A., Pamela Jo Johnson, Brian Lee, and Peter B. Scal. “When a Usual Source of Care and Usual Provider Matter: Adult Prevention and Screening Services.” Journal of General Internal Medicine 23, no. 9 (May 28, 2008): 1354–60. https://doi.org/10.1007/s11606-008-0659-0.

Bodenheimer, Thomas S., and Mark D. Smith. “Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians.” Health Affairs 32, no. 11 (November 1, 2013): 1881–86. https://doi.org/10.1377/hlthaff.2013.0234.

Douthit, Nathan T., Sakal Kiv, Tzvi Dwolatzky, and Seema Biswas. “Exposing Some Important Barriers to Health Care Access in the Rural USA.” Public Health 129, no. 6 (2015): 611–20. https://doi.org/10.1016/j.puhe.2015.04.001.

Friedberg, Mark W., Peter S. Hussey, and Eric C. Schneider. “Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health Care.” Health Affairs 29, no. 5 (May 1, 2010): 766–72. https://doi.org/10.1377/hlthaff.2010.0025.

Garfield, Rachel, and Kendal Orgera. “The Uninsured and the ACA: A Primer — Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act.” KFF, January 2019. https://files.kff.org/attachment/The-Uninsured-and-the-ACA-A-Primer-Key-Facts-about-Health-Insurance-and-the-Uninsured-amidst-Changes-to-the-Affordable-Care-Act.

Lester, Paula E., T. S. Dharmarajan, and Eleanor Weinstein. “The Looming Geriatrician Shortage: Ramifications and Solutions.” Journal of Aging and Health 32, no. 9 (October 2020): 1052–62. https://doi.org/10.1177/0898264319879325.

Ponce, Ninez A., Leighton Ku, William E. Cunningham, and E. Richard Brown. “Language Barriers to Health Care Access among Medicare Beneficiaries.” Inquiry: A Journal of Medical Care Organization, Provision and Financing 43, no. 1 (2006): 66–76. https://doi.org/10.5034/inquiryjrnl_43.1.66.

Rust, George, Jiali Ye, Peter Baltrus, Elvan Daniels, Bamidele Adesunloye, and George Edward Fryer. “Practical Barriers to Timely Primary Care Access: Impact on Adult Use of Emergency Department Services.” Archives of Internal Medicine 168, no. 15 (August 11, 2008): 1705–10. https://doi.org/10.1001/archinte.168.15.1705.

Spatz, Erica S., Joseph S. Ross, Mayur M. Desai, Maureen E. Canavan, and Harlan M. Krumholz. “Beyond Insurance Coverage: Usual Source of Care in the Treatment of Hypertension and Hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Examination Survey.” American Heart Journal 160, no. 1 (July 2010): 115–21. https://doi.org/10.1016/j.ahj.2010.04.013.

Winters, Paul, Daniel Tancredi, and Kevin Fiscella. “The Role of Usual Source of Care in Cholesterol Treatment.” The Journal of the American Board of Family Medicine 23, no. 2 (March 1, 2010): 179–85. https://doi.org/10.3122/jabfm.2010.02.090084.

Wolinsky, Fredric D., Suzanne E. Bentler, Li Liu, John F. Geweke, Elizabeth A. Cook, Maksym Obrizan, Elizabeth A. Chrischilles, et al. “Continuity of Care with a Primary Care Physician and Mortality in Older Adults.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 65A, no. 4 (April 1, 2010): 421–28. https://doi.org/10.1093/gerona/glp188.

Xue, Ying, Zhiqiu Ye, Carol Brewer, and Joanne Spetz. “Impact of State Nurse Practitioner Scope-of-Practice Regulation on Health Care Delivery: Systematic Review.” Nursing Outlook 64, no. 1 (January 2016): 71–85. https://doi.org/10.1016/j.outlook.2015.08.005.