A new article (PDF file: 4 pages / 98 KB. More about PDFs.) from the Academy's Robert Graham Center blasts "dysfunctional financing schemes" that prevent adequate funding of U.S. primary care. The article also presents possibilities for building "a stable and robust health system built on primary care."
Article Exposes Health System's Problems, Poses Solutions
By News Staff
12/14/2005
Robert Phillips Jr., M.D., M.S.P.H., director of the Graham Center in Washington, wrote the article, "Primary Care in the United States: Problems and Possibilities," published in the Dec. 10 British Medical Journal.
The U.S. health care system, says Phillips, "operates as a marketplace darling, consuming nearly 16 percent of the overall economy and nearly 25 percent of its overall growth. Its role as a reliable economic engine produces amazing technology and pharmaceutical development, but it also yields uninsurance and underinsurance, poor population health compared with other developed countries, and unethical disparities in both health and health care." He adds, "For all the U.S.'s fiscal largesse, there is relative underinvestment in primary care."
Medicare has long undervalued primary care; the program "often cuts its annual payments to cope with overspending on procedures in secondary and tertiary care," Phillips says. He advises separating funding for primary care from that allocated for secondary and tertiary care. Applying the Medicare sustainable growth rate formula separately for services covered by evaluation and management codes (mainly for primary care) and for services covered by other codes (mostly procedural and for secondary and tertiary care) may accomplish nearly the same thing, Phillips suggests. Such a separation would preserve access to the most important primary care functions even when Medicare funds are cut because spending targets have been exceeded (mainly because of procedural costs).
Phillips underscores the difficulties the three primary care specialties are having in transforming their care according to new models and in attracting new doctors. The work, settings and compensation of general internists and pediatricians are more similar to those of family physicians than to those of subspecialist internists or pediatricians, he says. "The political and clinical integration of these specialties could unify more than a third of all U.S. doctors and create a force for change."
Phillips concludes, "By some measures of sufficiency, the primary care workforce in the U.S. has never been more capable of caring for people. Is it just in time to witness its demise, or just in time to retool and transform its clinical models and role in the health care system? The problems and possibilities may be coming into adequate alignment to permit a previously unthinkable period of experimentation." He calls for experiments in "how primary care is financed, how it may be protected from financial cannibalism by secondary and tertiary care, how it is organised, and how it is taught."
The U.S. health care system, says Phillips, "operates as a marketplace darling, consuming nearly 16 percent of the overall economy and nearly 25 percent of its overall growth. Its role as a reliable economic engine produces amazing technology and pharmaceutical development, but it also yields uninsurance and underinsurance, poor population health compared with other developed countries, and unethical disparities in both health and health care." He adds, "For all the U.S.'s fiscal largesse, there is relative underinvestment in primary care."
Medicare has long undervalued primary care; the program "often cuts its annual payments to cope with overspending on procedures in secondary and tertiary care," Phillips says. He advises separating funding for primary care from that allocated for secondary and tertiary care. Applying the Medicare sustainable growth rate formula separately for services covered by evaluation and management codes (mainly for primary care) and for services covered by other codes (mostly procedural and for secondary and tertiary care) may accomplish nearly the same thing, Phillips suggests. Such a separation would preserve access to the most important primary care functions even when Medicare funds are cut because spending targets have been exceeded (mainly because of procedural costs).
Phillips underscores the difficulties the three primary care specialties are having in transforming their care according to new models and in attracting new doctors. The work, settings and compensation of general internists and pediatricians are more similar to those of family physicians than to those of subspecialist internists or pediatricians, he says. "The political and clinical integration of these specialties could unify more than a third of all U.S. doctors and create a force for change."
Phillips concludes, "By some measures of sufficiency, the primary care workforce in the U.S. has never been more capable of caring for people. Is it just in time to witness its demise, or just in time to retool and transform its clinical models and role in the health care system? The problems and possibilities may be coming into adequate alignment to permit a previously unthinkable period of experimentation." He calls for experiments in "how primary care is financed, how it may be protected from financial cannibalism by secondary and tertiary care, how it is organised, and how it is taught."
