Does Continuity of Care Matter in a Universally Insured Population?

Objective. To examine the relation between continuity of care and preventive health care and emergency department (ED) use in a universal health care system. Data Sources/Study Setting. Administrative data that capture health care use of the entire population of a midwestern Canadian city. Study Design. A population-based, retrospective study of all individuals who had a least one physician contact in 1998 or 1999 (total N5 536,893). Methods. Logistic regressions were conducted to examine the relation between con-tinuity of care, defined in terms of the proportion of total visits to family physicians (FPs) made to the same FP, and cervical cancer screening, breast cancer screening, influenza vaccination, pneumococcal vaccination, and ED visits, controlling for demographic variables, socioeconomic status (defined in terms of relative affluence of neighborhood of residence), and health status. Principal Findings. Continuity of care was related to better preventive health care and reduced ED use. A consistent socioeconomic gradient also emerged. For instance, the odds of having a mammogram was double for individuals living in the wealthiest neighborhoods, relative to those in the poorest neighborhoods (adjusted odds ra-tio5 2.31, 99 percent CI 2.13–2.50). Conclusions. Having a long-term relationship with a single physician makes a dif-ference even in a universal health care system. Moreover, socioeconomic disparities remain, suggesting the need to target specifically individuals from lower socioeconomic strata for preventive health care. Key Words. Continuity of care, socioeconomic status, preventive health care, emergency department use, administrative data Continuity of care, which is often defined as a long-term relationship between a patient and a physician, regardless of the presence of any specific disease (Starfield 1980; Haggerty et al. 2003), has long been thought to be an essential aspect of primary care (Starfield 1998). The benefits of continuity of care have been documented extensively and include reduced likelihood of hospitaliza