Letters

Population-based primary care

To the Editor:

I applaud Dr. Marc Rivo's "systems approach" to primary care ("It's Time to Start Practicing Population-Based Health Care," June 1998). Doing the same thing the same way for each person with each condition in a practice, and then studying our practices to ensure consistency and completeness in our approach, is the only way practices can have an impact on the incidence and prevalence of disease among our patients.

One technical point: population-based primary care is the system of health care services distribution that includes every person in a primary care practice located within a geographical area. And it creates incentives for every participating primary care practice to take responsibility for the health of every person assigned to it as well as all the other people in that area.

Population-based primary care represents a health care services distribution system that encompasses the ideals of family medicine: the universal availability of health care that is relationship-focused, community-based and lifelong. And it includes all the critical elements of a rational health care system: affordability, accessibility, fair distribution, respect for patient's autonomy and effectiveness in controlling the incidence and prevalence of disease.

Dr. Rivo describes the advantages of a practice-based systems approach. But I am thrilled any time we have the chance to discuss the advantages of population-based primary care, which is the horse family medicine should be riding in the race for rational health care reform.

Michael Fine, MD
Pawtucket, R.I.

Editor's note: Do you think population-based health care is an appropriate model for family practice? Could the "systems approach" to population-based primary care be adapted to your practice? Have you implemented this approach to improve the care of your patients? FPM is interested in your experiences with population-based health care. Use the fax reaction form with Dr. Rivo's article in the June issue (page 46) or e-mail us at fpmlet@aafp.org. We'll publish selected comments in an upcoming issue.

Patient resistance to managed care

To the Editor:

"I must say that I share Uwe Reinhardt's bewilderment regarding patients' resistance to their loss of freedom under managed care (See "Monitor," June 1998). After all, Professor Reinhardt worked tirelessly on the Clinton Administration's health care reform task force to bring the benefits of socialized medicine to the United States, only to watch the entire idealistic enterprise founder in a sea of second thoughts and doubts in 1993. Now patients refuse to acknowledge the achievements of the managed care industry.

I propose that the real failure may be a lack of historical perspective. After all, wasn't this nation founded by men who understood the importance of sacrificing individual liberty and freedoms for the common good? Perhaps if this were better understood, patients would more willingly surrender their rights and freedom under managed care and show a little more gratitude for the benefits bought with this loss of freedom.

David E. Hanson, MD
Savanna, Ill.

We want to hear from you. Letters is an open forum for our readers. Write to Letters Editor, Family Practice Management, 8880 Ward Parkway, Kansas City, MO 64114-2797. If you prefer, fax your letter to 816-333-0303. You may also contact FPM by E-mail at fpmlet@ aafp.org. Include your address, daytime phone number and fax number, if any. Letters may be edited for length and style. All letters sent to the editors of FPM are presumed to be intended for publication unless otherwise specified in the text of the letter.

Copyright © 1998 by the American Academy of Family Physicians.
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