Date of Award

Winter 2011

Project Type


Program or Major


Degree Name

Doctor of Philosophy

First Advisor

Heather A Turner


Recently developed models of health care provision have promoted the relationship between providers and patient for improving care continuity and coordination. This may be especially important for the growing population of elders, who often have fragmented care because of multiple chronic illnesses. Previous research shows that elders who have a usual source of care (USC) have better health and health care experiences than other elders. However, research has rarely considered whether the benefits of USCs may be affected by the elder's socioeconomic status (SES), their levels of chronic illness, or various provider characteristics.

This dissertation utilizes the 2007 Medicare Current Beneficiary Survey to examine the impact of SES and USC characteristics on the health, health care utilization, and processes of care. Among all elders, having a USC was associated with better processes of care, but not better health. Among elders who have a USC provider, there were no differences in the outcomes of elders based on the type of USC provider. The relationship between length of provider-patient relationship and health-related outcomes were unclear. Among all elders, higher SES elders reported better outcomes than did lower SES elders; however, SES did not impact the health care experiences of elders with a USC provider. The influence of SES was not mediated by USC or chronic conditions.

The conditional impact of chronic conditions was also examined. Higher SES elders reported better self-rated health than did lower SES elders for each additional chronic condition. Elders who had a USC had lower declines in satisfaction with access to care for each additional chronic condition than did elders who did not have a USC.

In conclusion, the USC seems important but insufficient for good health and health care experiences. Elders who have a USC report better processes of care, which are associated with improved health care utilization and health outcomes. However, having a USC does not reduce the influence of SES on the outcomes examined among all elders; higher SES elders report better health and health care experiences compared to lower SES elders even when the presence of a USC is taken into account.