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Improving Patient Care |

Innovations in Access to Care: A Patient-Centered Approach

Leonard L. Berry, PhD; Kathleen Seiders, PhD; and Susan S. Wilder, MD
[+] Article, Author, and Disclosure Information

From Texas A&M University, College Station, Texas; Boston College, Chestnut Hill, Massachusetts; and Mayo Clinic Scottsdale, Scottsdale, Arizona.

Acknowledgments: The authors thank Frank Davidoff, MD, Executive Editor, The Institute for Healthcare Improvement, and 3 anonymous reviewers for their detailed and constructive suggestions on earlier drafts of this paper. The guidance of Jane Roessner of The Institute for Healthcare Improvement Publications Group is appreciated, as is the research assistance of Ann Mirabito and Jed Grisel, students in Texas A&M University's marketing PhD program and medical school, respectively.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Leonard L. Berry, PhD, Department of Marketing, Mays Business School, Texas A&M University, 4112 TAMU, College Station, TX 77843-4112; e-mail, BerryLe@tamu.edu.

Current Author Addresses: Dr. Berry: Department of Marketing, Mays Business School, Texas A&M University, 4112 TAMU, College Station, TX 77843-4112.

Dr. Seiders: Carroll School of Management, Boston College, Fulton Hall, 4th Floor, Chestnut Hill, MA 02467.

Dr. Wilder: Mayo Thunderbird Family Medicine Center, 13737 North 92nd Street, Scottsdale, AZ 85260.

Ann Intern Med. 2003;139(7):568-574. doi:10.7326/0003-4819-139-7-200310070-00009
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The practical, operational issues of access to medical care services are pivotal to all patients. Unlike other marketplaces, where the consumer is the decision maker, employers, payers, and providers—rather than patients—primarily influence the way the health care system functions. Patients often find themselves on the outside of the system, such as when employers switch health plans and patients must scramble for new providers. Some consumers are leaving the “mainstream” system to obtain various medical services, for example, using concierge physicians who charge annual fees for upscale service, overseas hospitals for surgery, and walk-in radiology screening services. The fact that patients and providers are leaving the system threatens to make health care access and delivery even more difficult for those who remain (17).

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