​Authors developed a measure of individual user assessment of primary care and tested its association with health system performance and quality indicators. Survey data collected in 2013 from 20,045 respondents in OECD countries: Australia, Canada, France, Germany Netherlands, New Zealand, Norway, Sweden, Switzerland, The United Kingdom and the USA.

Reports of out-of-pocket expenses over $1,000, lack of receipt of appropriate/timely care (use of ER, consulting three or more doctors in past year) and of clinical prevention (blood pressure check in past year, cholesterol checked in the past 5 years, receipt of influenza vaccination in past year and report of any medical error) were measured and scored. Users experiencing poorer primary care were significantly more likely to report significant out-of-pocket expenses, emergency room use in the past 2 years, having consulted more than three doctors in the past year, lower likelihood of blood pressure or cholesterol screening or an annual flu shot and higher reports of medical error.