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

• Author: Kathryn H. Jacobsen,Lila C. Fleming
• DOI: http://doi.org/10.1002/wmh3.167
• Published date: 01 December 2015
• Date: 01 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

Introduction

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

368

1948-4682 #2015 Policy Studies Organization

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