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Comment & Response
Health Care Reform
March 2015

Access to Primary Care in England—Reply

Author Affiliations
  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Emergency Medicine, University of Pennsylvania, Philadelphia
  • 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
JAMA Intern Med. 2015;175(3):467-468. doi:10.1001/jamainternmed.2014.7871

In Reply The letter from Cowling and colleagues underscores that ensuring timely access to care is a challenge for health systems around the world. The United Kingdom (UK) has received high marks for access to primary care in cross-national comparisons of health systems.1 This is confirmed by the GP Patient Survey, which found that patients in the UK are able to obtain primary care appointments in less than 1 week on average.2 Higher levels of access in the UK have been explained by several structural and organizational factors. First, while the United States and UK have a similar ratio of physicians per population, a much higher fraction of these physicians provide primary care in the UK compared with the United States.3 Second, the UK National Health Service assigns patients to a regular primary care clinicians—a practice that has historically been limited to managed care plans in the United States. Finally, the presence of a salaried clinician workforce operating within a universal insurance coverage scheme in the UK reduces financial barriers to care for patients and promotes higher supply of health care services in low-income communities.

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