Federal healthcare reform efforts have focused on keeping people out of the hospital and getting them into primary-care offices for preventive care and health management. Projects to achieve this include the Federally Qualified Health Center Advanced Practice Primary Care Demonstration and the Comprehensive Primary Care Initiative.
But some low-income patients strongly prefer going to the hospital for primary care, and they give some good reasons for this. That's reason to think reformers may be pushing a rock uphill to try to change patient behavior.
A recent Health Affairs article, based on interviews with 40 hospitalized low-income patients between January 2011 and June 2011, found that low-income patients have more trust in healthcare delivered in the hospital setting and find primary care outside the hospital inaccessible and unaffordable.