Abbreviations: ADSS = Asthma Disease Severity Scale; ANCOVA = analysis of covariance; AQLQ = Asthma Quality of Life Questionnaire; ASUI = Asthma Symptom Utility Index; HRQL = health-related quality of life; HUI = Health Utilities Index; PSRS = Physician Severity Rating Scale; QALY = quality-adjusted life year; SALY = symptom-adjusted life year; SG = standard gamble; VAS = visual analog scale

The notion that continuity and adequacy of care are improved by having a usual source of care may have different implications in different types of health services. In particular, from a patient''s perspective, prevention is more voluntary (i.e., a matter of choice) than acute care. Having a usual source of care, in concept, can facilitate such planning. Although it is known that having a usual source of care improves access to preventive services, as discussed, whether a regular doctor contributes more than a regular site to the improvement of access to preventive services is yet to be explored.

An individual has a choice between a regular site and a regular doctor (and no usual source of care), as indicated by the two arrows starting at the decision node. This choice is determined by predisposing, enabling, and need factors. The chosen usual source of care, a regular doctor or site, along with predisposing, enabling, and need factors, affects discrete preventive service use (mammogram is shown for illustration purpose). However, the effect of having a regular doctor on service use (solid arrows) may be different from that of having a regular site (dashed arrows). Furthermore, unobservable preferences of the consumers, such as their risk aversion and health conscientiousness, affect both the use of preventive services and the choice of a usual source of care. That is, the consumers who are likely to use prevention may be those who are likely to have a usual source of care, controlling for their observable characteristics. Figure 1 demonstrates that the unobservable preferences cause the endogeneity o f the choice of a usual source of care.

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