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Population experiences of primary care in 11 Organization for Economic Cooperation and Development countries
James Macinko1, Frederico C Guanais2
1Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Center for Health Sciences, 650 Charles E. Young Dr. South, Room 31-235B, Los Angeles, CA 90095-1772, USA.
Objective:
To develop a measure of individual user assessments of primary care and test its association with health system performance and quality indicators.
Design:
Cross-sectional analysis of secondary survey data collected in 2013.
Setting:
Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.
Study Participants:
20 045 respondents.
Main Outcome Measures:
Individual report of financial protection (out of pocket expenses over USD 1000), lack of receipt of appropriate/timely care (use of the emergency room in the past 2 years, having consulted three of more doctors in the past year) and clinical prevention (blood pressure check in past year, cholesterol checked in the past 5 years, receipt of influenza vaccination in past year and report of any medical error).
Methods:
A score of users' primary care experiences was constructed from 14 individual survey questions. Multivariable Poisson and augmented inverse-probability weighted regression assess the relationship between the primary care experience score and outcomes.
Results:
Countries differed regarding the proportion of the population experiencing problems with primary care. In analyses controlling for age, sex, health status, chronic disease, income level and health insurance, users experiencing poorer primary care were significantly more likely to report significant out of pocket expenses, emergency room use in the past 2 years, having consulted more than three doctors in the past year, lower likelihood of blood pressure or cholesterol screening, an annual flu shot and higher reports of medical error.
Conclusions:
The measure of individual primary care experience can be used to differentiate among different country's primary care approaches and is strongly associated with overall health system performance and quality indicators.