—Dr Baker's admonitions about the importance of disease prevalence and severity are well taken, but since the poor have greater disease prevalence and severity, their compromised access is all the more striking. Dr Frey's comments echo my observation that compromised access to services for the socially disadvantaged is nothing new. As for Dr Jameson's comments about the importance of personal health behaviors, the data show clearly that health systems with greater access to care and higher use of primary care resources than in the United States have better health levels1 despite their greater prevalence of adverse behaviors such as smoking and drinking.2 His suggestion that access to care has reached the point of diminishing returns may be true for specialty care; it is almost certainly not true for primary care.
Starfield B. Access to Health Care and Preventable Hospitalizations-Reply. JAMA. 1995;274(22):1760. doi:10.1001/jama.1995.03530220025020