Patient-Centered Primary Care Offers Roadmap for Better Health

Today's health care system is at the brink of collapsing because of problems with the quality, accessibility and cost of health care. The United States spends more than 50 percent more per capita on health care than Switzerland, which ranks second -- yet our country stands 37th in overall health, according to the World Health Organization. That coincides with the growing prevalence of chronic disease: 120 million Americans suffer from a chronic medical condition, and 60 million of these have more than one. By 2030, more than 20 percent of the U.S. population will be older than 65, where multiple chronic conditions are more commonplace.

We're also seeing wide gaps in receiving care for preventing illness and managing chronic conditions. Only about half of patients who require preventive, chronic or follow-up care actually receive it. At the same time, the rate of uninsured adults in the United States is rapidly approaching 1 in 5, and growing.

And what has become of the patient-physician relationship? The most important decisions involving health and health care are made by families in the context of the duration, strength and trust of this relationship. Alarmingly, the small supply of family physicians is being depleted by our national priorities, economic incentives for specialization, the payment system for physicians and administrative burdens on small office practices.

That is eroding the ability of family doctors to provide continuous, comprehensive care. Patients are finding it increasingly difficult to receive the holistic, personal care that primary care physicians are trained to provide. This is a major reason for the bottleneck in local emergency rooms. We have no other place to go.

Our country needs a patient-centered primary care system -- where the personal care physician serves as an advocate who attends the total health care needs of patients before health issues become more serious and expensive. Patients should have a "medical home" where they can be treated by a personal physician who understands their overall physical and emotional needs. This leads to better, more personalized health care and a coherent plan for ongoing care in partnership with the physician or primary care professional.

Why should major companies support patient-centered primary care? Because research shows that patient-centered primary care results in better health care, lower costs, greater satisfaction with the health-care system and more equal access to health care for all citizens.

Studies have long shown that communities or countries where primary care is accessible have better health and higher life expectancy, as well as lower death rates for infants and for conditions like cancer and heart disease. A recent study found that an increase of just one primary care physician per 10,000 population (a 12.6 percent increase over the current supply) would save just more than 126,000 lives in the United States every year.

Consider Denmark, which spends approximately 9 percent of its gross domestic product on health care compared to 16 percent in the United States. Denmark has designed its health care system to support the relationship between patients and their personal physicians. Practices are set up to handle same-day appointments and walk-ins, off-hours care is readily available, and primary care doctors are reimbursed accordingly. An online infrastructure makes electronic medical records available to physicians and hospitals throughout the country.

But that is not the case in the United States, where employers -- and increasingly patients -- bear the financial burden of our current health care system. Patients bear the greatest human cost and consequences of our fragmented health care system. Those without health insurance and those who shuttle back and forth between specialists have far higher rates of avoidable hospitalization and poorer health than those who have an ongoing relationship with their primary care physician.

Let's start paving the road to better health. Employers can start by insisting that their health insurance providers support patient-centered primary care and the "medical home" by reforming health care benefits in line with reforms for the practice of primary care.

Professional medical societies must help primary care physicians transform their own practices to deliver patient-centered care and modernize by adopting appropriate information technology. Medical schools and physician training programs must raise the stature of primary care practice to attract physicians to this important field.

As patients, we must open our minds to primary care that is accessible and comprehensive and that advocates for our health care needs. The goal is not to restrict care. We need to get back to basics and design a system that starts from the inside out, with patients at the center, and the patient-physician relationship as the focus for improvement.

Editor's note: This article originally appeared in the March 18, 2007, issue of the Westchester (N.Y.) Journal-News. It is reprinted here with the author's permission.