The relationship between patients and their physicians is a key driver in how and if people proactively manage their health. But cost often gets in the way of that relationship between a patient-consumer and a primary care doctor.

The #1 reason why Americans deter proactive health care is cost. No American, whether insured and unemployed or working and covered, is immune from postponing or otherwise actively managing care when they are still well, according to a survey from IBM on health consumers in the U.S.

55% of Americans say they can’t afford the cost of wellness visits out-of-pocket. This is especially true for the uninsured (81%) and the unemployed (76%).

Among the 1 in 4 Americans who did not see their physician for a wellness visit in the past year, 54% do not believe that a visit is worth the out-of-pocket expense.

The chart details how Americans feel about doctors, both primary care practitioners (PCPs) and specialists. The survey found that people without a PCP have more negative views on doctors than people who have a regular primary care relationship. Thus, people without a ready relationship with a trusted PCP only go to doctors when they’re already sick.

The emergency room becomes the PCP for many, according to IBM. 7 in 10 of people say if their PCP allowed them to contact them after hours, they’d be less likely to visit an ER.

IBM concludes that, “a negative view of the healthcare system breeds more passive health management.”

IBM’s national health survey was conducted among 1,501 American adults 18 and over in late June 2009. The same was representative including insured, underinsured and uninsured individuals.

Health Populi’s Hot Points: IBM’s survey highlights the importance of a medical home for Americans. Those health systems around the world with a strong primary care backbone (including a regular primary care home for each citizen) spend far less on health care per capita.

IBM found that people without a regular source of primary care are less trusting in the health system, and are less likely to proactively manage health. This lack of a regular PCP relationship, or medical home, breeds poorer outcomes and higher costs.

Technology has a major role to play in getting and keeping health citizens connected to the health system for wellness and triage of urgent conditions, along with ongoing management of chronic disease. But without that connection and trust between a health citizen and her doctor, technology will be an add-on and not a platform for building individual and public health.