Call for Health System Reform Reaching Grassroots Level

Medical, business and consumer groups are calling for a change in the U.S. health care system, and many of them agree that a primary care foundation is vital to ensuring that the system works.

As these groups urge the federal government to overhaul the nation's medical care system, they also are calling for improved payment for primary care services and emphasizing the use of personal medical homes -- viewpoints that reflect positions long held by the Academy.

Those who call for comprehensive reform focused on primary care cite numerous studies demonstrating that the current subspecialist-based system results in fragmented, expensive care and disappointing outcomes.

"We know we make a difference because the research is very clear," said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "The research has shown that primary care and the personal medical home make a positive difference in health care. The debate is over."

The United States -- with its low primary care physician- and high subspecialist-to-population ratios -- compares poorly on health care status indicators when compared to other nations, say several studies. For example, America has the highest infant mortality rate among the 29 member nations of the Organization for Economic Cooperation and Development, according to "The U.S. Health Care System: Best in the World, or Just the Most Expensive?" (PDF file: 8 pages / 191 KB. More about PDFs.) a paper prepared by the University of Maine.

A national scorecard on U.S. health system performance from The Commonwealth Fund shows the United States has one of the lowest healthy life expectancy rates for people older than age 60, some of the highest insurance administrative costs and among the lowest use of electronic health records, or EHRs. Still other reports demonstrate that areas with strong primary care systems have better health outcomes and lower costs than those with subspecialty-dominated care.

Although few political observers expect significant congressional action this year on physician payment reform, health information technology or the physician workforce, those issues likely will surface in the 110th Congress, according to Kevin Burke, director of the AAFP Division of Government Relations. How these issues are handled will depend largely on the outcome of the mid-term elections, he said.

Despite virtually all lawmakers in the 109th Congress agreeing the U.S. health care system needed reform, legislation to revamp physician payment and medical liability became trapped in circular demands as members of Congress wrangled over which reform should come first. Some lawmakers demanded implementation of quality improvement reporting before fixing physician payment. However, quality improvement reporting first requires widespread implementation of health information technology, "But physicians aren't likely to invest in costly information technology unless they know they have a positive, reliable income stream," said Burke.

Meanwhile, the Senate failed to bring medical liability reform to the floor for a vote, and health information technology legislation got bogged down in a conference between the House and the Senate.

Academy reform efforts have strengthened the chorus of support for systemwide change. Since the 2004 publication of the Future of Family Medicine, or FFM, report, the Academy's advocacy efforts for health system reform have gained steam -- and supporters.