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In addition to improving access and utilization of medical care, having a usual source of care can facilitate the use of clinical prevention services in the population. It appears that adequate clinical prevention, such as immunization and cancer screening, can be better achieved through a usual source of care because the care provider has a more comprehensive understanding of a patient''s health needs. Specifically, empirical evidence found that individuals with a usual source of care were more likely to receive timely immunizations (Flocke, Stange, and Zyzanski 1998; Frank et al. 1995; Mark and Paramore 1996) and that women who had a usual source of care were more likely to receive breast and cervical cancer screening (Bindman et al. 1996; Ettner 1996; KagawaSinger and Pourat 2000; O''Malley et al. 1997; Zambrana et al. 1999). In addition, one study demonstrated that having a usual source of care promoted healthier behaviors, such as exercise and quitting smoking (Ettner 1999). Although many studies have investigated the effect of having a usual source of care on an individual''s care-seeking behavior, most do not distinguish between having a regular doctor and having a regular site. Because of the positive association between having a regular doctor and improved access to care (Alpert et al. 1970; Becker, Drachman, and Kirscht 1974; Dietrich and Marton 1982; Starfield 1992), patients'' preferences to see their usual physicians were included as one of the four domains in the Components of Primary Care Instrument (Flocke 1997). In two earlier studies comparing the effects of having a regular site and having a regular doctor (Marcus and Stone 1984; Scitovsky, Benham, and McCall 1979), it was found that having a regular doctor resulted in a higher frequency of physician visits relative to having a regular site.

To further our understanding of the role of a usual source of care in ensuring that adequate and continuous prevention can be provided to the population, this study examined the relative effectiveness of having a regular doctor as compared to a regular site on individuals'' use of various preventive services. Following Ettner (1996; 1999) and Kuder and Levitz (1985), in which the endogeneity of having a usual source of care was controlled for, this study answered the following questions:1. Does having a regular doctor have a greater impact on a patient''s receipt of preventive services than having a regular site?

2. In what preventive services do we observe the comparative advantage of having a regular doctor over having a regular site?CONCEPTUAL FRAMEWORKIntuitively, individuals, especially those who have one or more chronic conditions, would prefer having a usual source of care in order to receive continuous monitoring and medical attention. Also, having a usual source of care can improve the timeliness and comprehensiveness of the receipt of preventive care for health conscientious or risk-averse individuals. Because both groups of individuals are concerned about their health, they may seek out services more aggressively (Ettner 1999). Thus, when a usual source of care is present in the service utilization process of these two groups of individuals, more observed service use does not necessarily imply that the usual source of care is the cause of the increased utilization of prevention. The endogeneity of having a usual source of care was also examined by Kuder and Levitz (1985), in which they conceptualized the relationship between having a usual source of care and physician visits under the behavioral model specification (Aday and Andersen 1984; Andersen and Aday 1978; Andersen and Newman 1973; Andersen 1995). In a traditional behavioral model, individuals'' predisposing, enabling, and need factors are used in predicting service use. Having a usual source of care, one of the enabling factors, is treated as predetermined (i.e., independent of predisposing, need, and other enabling factors) in explaining service use. However, numerous empirical studies rejected such an independence assumption (Hayward et al. 1991; Hayward et al. 1988; Merzel 2000; Rask et al. 1994; Schur, Albers, and Berk 1995). In these studies, the probability of having a usual source of care was modeled by using a subset of predisposing, enabling, and need factors, such as insurance status, as explanatory variables. Thus, the traditional behavioral model did not capture the intermediacy of having a usual source of care in linking predisposing, enabling, and need factors to service use. More importantly, many previous studies ignored the fact that the choice of a usual source of care was correlated with the error term in a regression of service use, controlling for observable consumer characteristics. Figure 1 illustrates a modified structure of the behavioral model.

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