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Access to Health Care and Preventable Hospitalizations

John J. Frey, MD
JAMA. 1995;274(22):1760. doi:10.1001/jama.1995.03530220025018.
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To the Editor.  —In the article by Dr Bindman and colleagues1 it was unsettling to see the authors state that "[a]ccess to care was inversely associated with the hospitalization rates for the five chronic conditions." This is not because their data are incompatible with many of our experiences, but because they echo the landmark article by Hart2 published 24 years ago in which he first used the term "inverse care law." Hart showed, via analyses of the burdens of illness in regions of Great Britain with variations of social class and variations of physician quality, that "the availability of good medical care tends to vary inversely with the need for it in the population served." At the time, Hart's "law" stirred many in the National Health Service to address inequities in quality and access for the working class and the poor in both urban and rural areas of


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