Insurance Coverage is Only Half the Equation to Patient Access to Health Care

FOR IMMEDIATE RELEASE: Monday, February 10, 2014

Leslie Champlin
Senior Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237, Ext. 5224 

WASHINGTON — An insufficient number of primary care physicians may undermine the positive impact of increasing the number of Americans who have health care coverage, according to research published in the International Journal of Family Medicine. The research, “The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States(,” found that people who had a usual source of health care were less likely to rely on emergency services, regardless of their insurance status. However, an inadequate primary care workforce may hinder patients’ ability to get needed care in the community. 

Researcher Winston Liaw, MD, professor of medicine at the Virginia Commonwealth University, and his coauthors looked at how the interplay between insurance coverage and having a usual source of care affected reliance on emergency department services. The research was sponsored by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

Liaw and his colleagues conducted a trend analysis of factors influencing settings where patients aged 18 to 64 sought care from 2000 to 2011 using data from the Medical Expenditure Panel Survey, the U.S. survey that estimates health services use, expenditures and sources of payment.

The results showed that regardless of whether patients were privately insured, covered by Medicaid or uninsured, those who had a usual source of care used more ambulatory services compared to patients without a usual source of care. However, those with usual sources of care were less likely to rely on emergency departments.

“Those who lack a usual source of care, particularly the uninsured and Medicaid enrollees, are more likely to rely on EDs,” the researchers noted. “Health systems should support policies that expand access to usual sources of care for low-income patients.”

Moreover, the study demonstrates the importance of a strong primary care workforce that doesn’t congregate in suburban areas but is more equally distributed in rural and urban areas.

“Our findings show that if you’re in an area where there are no doctors accepting Medicaid or no doctors accepting new patients, that will affect your access to community-based care,” Liaw said. “You may be insured, but if you don’t have a relationship with a medical home, you’re more likely to rely on the emergency room.”

Liaw said the results have implications for legislators and policy makers whose decisions affect medical education, payment for health care services and physician workforce. “Their decisions are going to be very important for ensuring that people have access to care and use that care more efficiently. We need to expand access to primary care everywhere, and if the incentives aren’t there, fewer students will want to go into primary care. Nurse practitioners and physician assistants respond to the same incentives as doctors. Without adequate payment for primary care, the access problem is going to be there.” 

The results are also a wake-up call to community-based primary care physicians, he added. “This is a call to medical homes to do everything they can do to improve access,” Liaw said. “They need to offer more walk-in services and extended hours. We need to do everything we can do to be patient-centered so people can get care when they need it.”


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.