Improved hospital services and a faltering primary care system may have some Philadelphia residents choosing to go to the emergency room for care instead of a doctor's office. That's according to a new study out of the University of Pennsylvania, published in this week's issue Health Affairs. The study honed in on the experiences of 40 low-income patients, some with insurance and some without, who sought care at a University of Pennsylvania hospital in 2011. It found that most patients had opted to wait until their health conditions worsened to the point of needing emergency care. It's not that patients wanted to be sick, said Kangovi, but rather the primary care system "is riddled with barriers that end up driving patients away." What the region and nation is left with, she says, is "an inefficient way of delivering care."