International Perspectives on Primary Care Access, Equity, and Outcomes for Children.

Numerous studies, across multiple health systems, have demonstrated the value to child health of accessible and high-quality primary care.1–4 The past decade has witnessed an unprecedented pace of primary care reform, most not specific to children. Although the health policy contexts and mechanisms vary across jurisdictions, a common goal of reform efforts is access to timely care with a focus on both extending hours, and providing same or next day care for sick visits. According to the most recent international Commonwealth Fund study,5 there is wide variation reported by (adult) patients on both access measures. The United Kingdom ranked highest on after-hours care (69%), yet use of emergency departments (EDs) by children is higher than in the United States, which ranks eighth on this access metric (39%) and continues to have underinsurance problems. Many countries report high (and in some cases increasing) nonurgent ED visit rates by children,6–9 and in England additional concerns have been raised around increasing short-stay admissions.10 Whether these trends relate to ineffective primary care reform for children’s needs or factors outside of the primary care system is not well understood.