Primary Care – Will It Survive?
By Thomas Bodenheimer, M.D.
The New England Journal of Medicine
August 31, 2006
The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.”
And indeed, primary care is facing a confluence of factors that could spell disaster. Patients are increasingly dissatisfied with their care and with the difficulty of gaining timely access to a primary care physician; many primary care physicians, in turn, are unhappy with their jobs, as they face a seemingly insurmountable task; the quality of care is uneven; reimbursement is inadequate; and fewer and fewer U.S. medical students are choosing to enter the field.
Even as primary care spirals further into crisis, studies have demonstrated that a primary care-based health care system has the potential to reduce costs while maintaining quality. The hospitalization rates for diagnoses that could be addressed in ambulatory care settings are higher in geographic areas where access to primary care physicians is more limited. States with a higher ratio of generalist to population have lower per-beneficiary Medicare expenditures and higher scores on 24 common performance measures than states with fewer generalist physicians and more specialists per capita.
Serious effort is required to develop a national primary care payment policy. Public policy on primary care does not exist; the fortunes of primary care are dictated not by the health care needs of the country but by a specialty-rich, quantity-based reimbursement system. Few legislators, particularly among those responsible for the trend-setting Medicare program, are aware that primary care is struggling. An educational campaign is needed – to explain the nature and causes of the threats to primary care’s survival; to provide well-documented information on the benefits of primary care, focusing on the potential for a strong primary care-based system to control health expenditures; and to offer concrete proposals for reforming both primary care at the microsystem level and the payment scheme at the macrosystem level.
Whoever takes up the cause of primary care, one thing is clear: action is needed to calm the brewing storm before the levees break.
Primary Care – Will It Survive? By Thomas Bodenheimer, M.D.
http://content.nejm.org/cgi/content/full/355/9/861
Also, Primary Care – The Best Job in Medicine? By Beverly Woo, M.D.
http://content.nejm.org/cgi/content/full/355/9/864
Comment:
Don McCanne, MD
“Crisis” is a word that has been thrown around lately to describe many of the trends that are resulting in higher health care costs, but without an improvement in coverage and access. When it comes to the deterioration that is taking place within our primary care infrastructure, “crisis” is not an adequate term. It’s much worse.
Both of the articles above provide an excellent, brief description of the status of primary care. The issue is of such great importance that the editors of the NEJM have provided free access to both of these articles.
They should be downloaded to be used in your health reform advocacy activities. Particularly valuable are the four graphs (two in each article) that can be downloaded as PowerPoint slides.
We need immediate macrosystem reform. We need single payer now!