Access to Health Services

PCPs play an important role in the general health of the communities they serve. However, there has been a decrease in the number of medical students interested in working in primary care.20 To improve the Nation's heath, it is important to increase and track the number of practicing PCPs.

Emerging Issues in Access to Health Services

Access to health care services in the United States is regarded as unreliable; many people do not receive the appropriate and timely care they need. The U.S. health care system, which is already strained, will face an influx of patients in 2014, when 32 million Americans will have health insurance for the first time. All of these issues, and others, make the measurement and development of new strategies and models essential.

Specific issues that should be monitored over the next decade include:

  • Increasing and measuring access to appropriate, safe, and effective care, including clinical preventive services.
  • Decreasing disparities and measuring access to care for diverse populations, including racial and ethnic minorities and older adults.
  • Increasing and measuring access to safe long-term and palliative care services and access to quality emergency care.


1 Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Millman M, editor. Washington: National Academies Press; 1993.

2Bierman A, Magari ES, Jette AM, et al. Assessing access as a first step toward improving the quality of care for very old adults. J Ambul Care Manage. 1998 Jul;121(3):17-26.

3Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report 2008. Chapter 3, Access to healthcare. Washington: AHRQ; 2008. Available from: http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhdr08/nhdr08.pdf

4Hadley J. Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition. JAMA. 2007;297(10):1073-84.

5Insuring America's health: Principles and recommendations. Acad Emerg Med. 2004;11(4):418-22.

6Durham J, Owen P, Bender B, et al. Self-assessed health status and selected behavioral risk factors among persons with and without healthcare coverage—United States, 1994-1995. MMWR. 1998 Mar;13;47(9):176-80.

7Starfield B, Shi L. The medical home, access to care, and insurance. Pediatrics. 2004;113(5 suppl):1493-8.

8De Maeseneer JM, De Prins L, Gosset C, et al. Provider continuity in family medicine: Does it make a difference for total health care costs? Ann Fam Med. 2003;1:144-8.

9US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2010, 2nd ed. With understanding and improving health and objectives for improving health. 2 vols. Washington: Government Printing Office; Nov 2000, p.45. Available from: http://www.healthypeople.gov

10 Institute of Medicine. Primary care: America's health in a new era. Donaldson MS, Yordy KD, Lohr KN, editors. Washington: National Academies Press; 1996.

11Mainous AG 3rd, Baker R, Love MM, et al. Continuity of care and trust in one's physician: Evidence from primary care in the United States and the United Kingdom. Fam Med. 2001 Jan;33(1):22-7.

12Starfield B. Primary care: Balancing health needs, services and technology. New York: Oxford University Press; 1998.

13National Commission on Prevention Priorities. Preventive care: A national profile on use, disparities, and health benefits. Washington, DC: Partnership for Prevention; Aug 2007.

14National Commission on Prevention Priorities. Data needed to assess use of high-value preventive care: A brief report from the National Commission on Prevention Priorities. Washington: Partnership for Prevention; Aug 2007.

15Rose DJ, Lantz PM, House JS, et al. Health care access and the use of clinical preventive services. Paper presented at: Annual Meeting of the American Sociological Association; 2006 Aug 10; Montreal, Quebec. Available from: http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual.htm

16Massachusetts General Hospital (MGH), Department of Emergency Medicine. Prehospital care: Emergency medical service [Internet]. Boston: MGH; 2010. Available from: http://www.mgh.harvard.edu/emergencymedicine/services/treatmentprograms.aspx?id=1433

17Institute of Medicine (IOM). Future of emergency care series: Emergency medical services: At the crossroads. Washington: IOM; 2006.

18Agency for Healthcare Research and Quality. National healthcare disparities report 2008 [Internet]. Washington: Agency for Healthcare Research and Quality; 2008. Chapter 3, Access to healthcare. (AHRQ publication; no. 09-0002). Available from: http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhdr08/nhdr08.pdf

19Hsai RY, Tabas JA. The increasing weight of increasing waits. Arch Intern Med. 2009 Nov 9;169(20):1826-1932.

20Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2004-2005: Trends in primary care specialties. JAMA. 2005 Sep 7;294(9):1075-82.

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