Inequitable access: provider characteristics and reimbursement policies of primary care office sites in Milwaukee

Availability of primary physician care is a key determinant of health care access. While inequities in access can be related to individual and health care system characteristics, this study focused on the organizational characteristics of the health care system and examined the availability and accessibility of primary care physician offices in Milwaukee, Wisconsin. The study design was a secondary analysis of data extracted from a database of information about physician offices established for case management purposes. Analyzed data related to provider characteristics--geographic distribution, types of practice, hours of practice, and acceptance of new patients--and reimbursement policies. Results indicated there were barriers to primary care access in Milwaukee. Although the majority of physicians accepted new patients, most providers were available only during standard business hours, were located outside the center city, and limited acceptance of patients who were on Medicaid or had no health insurance. Access improves when there is a medical home and a single clinician coordinating patient health care. This is the role of primary care, and this study supports the need for expanded availability of primary care practitioners.