Blog & News
BRFSS Estimates Show Potential Break in Series for Usual Source of Care: New Data on State Health CompareOctober 20, 2022:
A change to the 2021 BRFSS’ “personal doctor” question has led to large changes in the share of respondents reporting having no personal doctor
The Center for Disease Control’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) is a long-running, telephone-based state survey designed to monitor trends in adults’ health-related risk behaviors, chronic health conditions, and use of preventive services. SHADAC uses the BRFSS to produce state-level estimates of a number of different measures of health care access and affordability, health behaviors, and outcomes. These measures are posted on State Health Compare and are available by subgroup and over time.
Among these measures is Adults with No Personal Doctor, which quantifies the share of adults who report having no personal doctor. SHADAC tracks this measure because adults with a personal doctor are thought to have better access to care than those with no personal doctor.
The 2021 estimates of those reporting no personal doctor shifted dramatically and across nearly every measured subgroup and state. Notably, these large shifts in estimates corresponded with a change in how the BRFSS asks respondents if they have a personal doctor.
Because of this change in methodology and the large, uniform shift in resulting data across various subgroups, we believe the 2021 BRFSS represents a break in series for estimates of “no personal doctor” (and related measures) and do not recommend comparing 2021 estimates to those from prior years.
This blog post describes changes to the “personal doctor” question and presents evidence of the impact this change had on estimates across the states and relevant subpopulations.
Changes to the “personal doctor” question structure
The table below compares the text of the “personal doctor” question asked in the BRFSS between 2000 and 2020 and the text of the question asked in the 2021 BRFSS. The main difference is that in 2021, the question broadens the concept of “personal doctor” by suggesting respondents consider groups of doctors when identifying whether they have a personal doctor. Specifically, the 2021 question specifically prompts the respondent if there is “one person or a group of doctors” (emphasis added) providing care whereas the question asked through 2020 only asks if there is more than one person who they think of as a personal doctor if the respondent has already indicated they don’t have one person they think of as their personal doctor.
|"Do you have one person you think of as your personal doctor or health care provider? [If No, read: Is there more than one, or is there no person who you think of as your personal doctor or health care provider?]"
1 Yes, only one
2 More than one
7 Don't know / not sure
|"Do you have one person or a group of doctors that you think of as your personal health care provider?"
1 Yes, only one
2 More than one
7 Don't know / not sure
Fewer people say they have “no personal doctor” using the 2021 question than in previous years
The primary result of this questionnaire change is that fewer people report having “no personal doctor” or other health care provider under the 2021 question compared with the question asked through 2020. This effect is nearly universal among many groups and across nearly every state. This type of change is uncommon and typically results from an update to the survey or its methods rather than from a true change in the population.
As shown below, the 2021 rate of 16.7% was far outside the range of estimates observed since 2011,1 which have been as high as 23.8% in 2013 and as low as 21.5% in 2015.
Percent reporting "no personal doctor" in the 2021 BRFSS was the lowest it has been in 10 years
The figures below present estimates of the share of the adult population who report having no personal doctor, comparing estimates from the 2020 and 2021 BRFSS. As shown in the figure on the left, the total percent of adults reporting no personal doctor was 6.4 percentage points (PP) lower in the 2021 survey (16.7%) compared to the 2020 survey (23.1%). Similar differences were observed across all measured groups (except for uninsured adults), with PP differences ranging from 2.5 PP among adults age 65 or older to 10.0 PP among adults age 25 to 34. As shown in the figure on the right, this was also true across the states, with a smaller share of adults reporting “no personal doctor” in the 2021 BRFSS compared to the 2020 survey in all but Delaware and Oregon. The difference ranged from 2.9 PP in Massachusetts to 13.4 PP in North Dakota.
Percent reporting "no personal doctor" dropped among most groups and nearly all states in the 2021 BRFSS
Further, these results hold when controlling for multiple factors in a multivariate analysis. In a variety of models, all controlling for the factors shown in the previous figures, respondents to the 2021 BRFSS were significantly less likely to report having no personal doctor than respondents to the 2020 BRFSS, with effects ranging from 4.1 PP (Model B) to 4.9 PP (Model C).
Multivariate analysis of rates of “no personal doctor” in 2021 BRFSS vs. 2020 BRFSS
|Model A||Model B||Model C||Model D|
|Model type||OLS, robust SEs||OLS, robust SEs||Survey-weighted OLS||Survey-weighted OLS|
|State fixed effects||No||Yes||No||Yes|
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1 The BRFSS implemented cell phone sampling and an advanced weighting method in 2011. For this reason, estimates from before 2011 are not comparable to those from 2011 and later.