EPIC: A Framework for the Factors That Influence the Selection of Health‐Care Providers

AuthorKathryn H. Jacobsen,Lila C. Fleming
Published date01 December 2015
Date01 December 2015
EPIC: A Framework for the Factors That Inf‌luence the
Selection of Health-Care Providers
Lila C. Fleming and Kathryn H. Jacobsen
The decision about where to seek health-care services once the need for care has been established is
an important step in health-care access. We conducted a systematic review of the maternal and child
health literature to identify articles about health services accessibility. We then used a qualitative
thematic synthesis approach to develop themes from the codes in eligible articles and to integrate
those themes into a comprehensive model of the factors that affect health-care provider selection once
the decision to seek formal medical care has been made. The EPIC model captures four main
provider selection factors from the included articles: environment (such as travel distance and
transportation access), provider (level of care, services, ownership, staff‌ing, equipment and supplies,
and reputation), individual (socioeconomic and health status), and cost (price and time). All aspects
of the EPIC model should be considered when studying and developing location-specif‌ic strategies to
improve access to and choice of health-care providers.
KEY WORDS: health services, health services accessibility, health-care quality, access, and evaluation,
maternal health services, patient acceptance of health care, patient participation
Health-care access can be considered to be a four-step cycle of (1) deciding to
seek care from a clinician after determining that professional clinical assistance is
required, (2) selecting a particular health-care provider to consult from among the
many types of providers and specif‌ic clinicians available, (3) following through on
the identif‌ied need for clinical services by visiting the selected provider for
diagnostic and therapeutic care, and then (4) evaluating the level of satisfaction
with the health-care services received from the provider and the willingness to
seek health-care services from that provider again in the future (Figure 1). Health-
seeking behavior (Step 1) and patient satisfaction (Step 4) are generally well-
studied. The decision about where to seek services (Step 2) has been less explored
but is of critical importance for health-services research and policy. How do
individuals and families decide what type of health-care provider to visit—a clinic
or hospital, a generalist or specialist, the nearest clinician or one whose off‌ice is on
World Medical & Health Policy, Vol. 7, No. 4, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

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