NCPA - National Center for Policy Analysis

After-Hours Access to Primary Care Practices Linked to Better Care

January 2, 2013

One key provision of the Affordable Care Act seeks to improve a patient's access to a primary care physicians and the coordination of that care. An important ingredient in achieving that goal is ensuring that patients have access to their primary care practice outside of regular business hours, says Ann S. O'Malley, a senior fellow at the Center for Studying Health System Change.

One method of increasing the availability of primary care physicians is to extend clinic hours. This has increased the volume of patients, as many individuals that work or have children find it easier to go to a clinic during non-regular hours.

  • In 2010, 40.2 percent of people said their primary care clinics offered extended hours, such as at night and on weekends.
  • One in five people found it very difficult or somewhat difficult to reach their clinician after hours.
  • People that reported less difficulty reaching a physician after hours had fewer emergency department visits (30.4 percent compared to 37.7 percent).
  • Furthermore, there were lower rates of unmet medical needs (6.1 percent compared to 13.7 percent).

This is especially important considering that relatively minor medical problems require a visit to the emergency room when primary clinics are closed. This increases overall health spending as resources are allocated inefficiently since emergency room visits cost more than primary care visits.

One problem is that the current fee-for-service system makes it difficult to coordinate after-hours care with a patient's regular doctor. This is problematic considering that providers that know a patient well, or at the very least have a patient's medical record, are able to give better quality of care.

To make after-hours care more available and better coordinated will require that financing is changed to align payment incentives between primary care and emergency department or urgent care centers.

Source: Ann S. O'Malley, "After-Hours Access to Primary Care Practices Linked With Lower Emergency Department Use and Less Unmet Medical Need," Health Affairs, December 2012.


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