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METHODSStudy SitesWe initially selected 40 VA nursing homes for possible inclusion in the study. Nursing homes were selected so as to meet the following three characteristics. First, they were to represent diverse geographic areas. Second, they were to vary in size, with approximately half having fewer than 100 beds. Third, nursing homes were to differ in their quality of care as measured by the rate of pressure ulcer development calculated from an administrative database. Two nursing homes were dropped from this initial list because we could not identify a local liaison to assist with data collection, two were dropped due to delays in obtaining institutional approval, and one was dropped from the analyses due to its exceptionally small size, with resulting limited information on performance. Thus, our final sample consisted of 35 nursing homes.

Table 3 shows the selected parameter estimates from the second-stage estimation. As discussed, the adjusted Wald tests of whether the coefficients of the [lambda]''s were zero were the tests for the endogeneity of having a regular doctor or site. The last column of Table 3 reports the result of the joint tests. The endogeneity of having a regular doctor or site was present for flu shots, blood pressure checkups, and cholesterol level checkups. No selection biases were found in the equations of pap smears or mammograms within the past two years.As described before, the effects of having a regular doctor ([I.sub.d]) and having a regular site ([I.sub.s]) conditional on the choice of a usual source of care are [gamma]1 + ([[alpha].sub.d][[lambda].sub.d] - [[alpha].sub.0][[lambda].sub.0]) and [gamma]2 + ([[alpha].sub.s][[lambda].sub.s] - [[alpha].sub.0][[lambda].sub.0]), respectively. These two effects are show in Table 4. Marginal effects of having a regular doctor and a regular site on the probabilities of receiving preventive services were reported. The [lambda]''s were calculated for each individual based on the predicted probabilities from the first-stage estimation. Because the [lambda]''s vary by individuals, the averages of the [lambda]''s were used in calculating the marginal effects.

The association of age and gender with self-perceived health has varied in previous studies. Some have reported that old people perceive their health in positive terms [8, 14, 16, 18] and tend to over-estimate their health compared with objective health measurements [15, 19, 20]. Other data support the view that elderly people are more pessimistic in their perceptions of their own health than younger people [21], even after controlling for objective health conditions [22]. Elderly men tend to report poorer health than elderly women for similar objective health conditions [15, 17, 18]. Poor education and low socio-economical status are associated with poor self-rated health [14, 20, 23]. The number of symptoms and medical conditions, depression, heart disease, stroke, decreased functional capacity and sensory problems all correlate positively with low self-rated health [1, 14-21].

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