III. Access: The percentage of adults reporting they do not have a usual source of care is increasing.

Sustained, personal relationships between patients, their families, and their primary care team are considered foundational to high-quality primary care. Studies have repeatedly shown that having this regular, or usual, source of health care improves patient outcomes and reduces unnecessary utilization of emergency rooms and hospitals.22,23

Despite the value of relationships in patient care, 27% of US adults reported no usual source of care or reported that the emergency room was their usual source of care in 2020, up from less than one-quarter (23.6%) in 2010. The percentage of children with no usual source of care was flat for most of the time period (Figure 5). There was a decrease in reports of no usual source of care for both groups from 2019 to 2020, but this one-year trend should be tracked over time before any conclusions can be made about the impact of the COVID-19 pandemic on usual source of care.

Figure 5. Percentage of the US Population Without a Usual Source of Care

It is notable that this trend occurred in spite of steadily decreasing rates of uninsurance, due to Affordable Care Act coverage expansions.24 Their source could be underinsurance, inadequate physician supply, or changing patient behavior. Regardless of the cause, there appear to be fewer of the long-term clinician-patient relationships considered intrinsic to the NASEM definition of high-quality primary care.


22. Liaw W, Petterson S, Rabin DL, Bazemore A. The impact of insurance and a usual source of care on emergency department use in the United States. Int J Family Med. 2014;2014:842847. doi:10.1155/2014/842847
23. Villani J, Mortensen K. Nonemergent emergency department use among patients with a usual source of care. J Am Board Fam Med. 2013;26(6):680-691. doi:10.3122/jabfm.2013.06.120327
24. Assistant Secretary for Public Affairs. New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act. U.S. Department of Health and Human Services. Published June 5, 2021. Accessed August 16, 2022. https://www.hhs.gov/about/news/2021/06/05/new-hhs-data-show-more-americans-than-ever-have-health-coverage-through-affordable-care-act.html

Jabbarpour Y., Petterson S., Jetty A., Byun H.,The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care, The Milbank Memorial Fund and The Physicians Foundation. February 22, 2023.


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