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Comment & Response | Health Care Reform

Access to Primary Care in England—Reply

Brendan Saloner, PhD1; Karin V. Rhodes, MD, MS2,3; Daniel Polsky, PhD, MPP3
[+] 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.
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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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March 1, 2015
Thomas E. Cowling, MPH; Matthew J. Harris, MBBS, DPhil; Azeem Majeed, MD
1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England
JAMA Intern Med. 2015;175(3):467. doi:10.1001/jamainternmed.2014.7853.
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