Primary Care Policy
The following is the introduction to a paper which I’m currently attempting to publish. Please do not distribute without my permission I feel strongly that primary care is the key improvement to fixing our current health care system. There are many “broken” aspects of our health care system- from the payment system to the over-reliance on hospitals. This is an introduction to my thoughts on how and why we are in this place and one of the key pieces of the solution–improving medical education.
History of a System in Crisis
Health care in the United States is currently fractured, specialized, low quality, and most importantly expensive. In comparison to other nations in the developed world, it is clear that the United States lags behind in important areas such as public health and health system cohesiveness. The current system relies largely on expensive specialty care, while primary care is not fully supported. The system that the United States currently employs is not inherently bad or wrong ideologically if this system were performing at similar levels as other nations. While performance on many key comparisons are similar in the United States for a wide variety of health markers, there is one area that is greatly out of balance—cost.
The current system in the United States is able to maintain average health outcomes, but for a much higher price. This one clear fact is indisputable, and is the spark to drive towards a more efficient and cost effect health care delivery system. The current system, with the decline in primary care, is a product of years of history of culture, education, political, and policies.
This system supports specialized care at the expense of primary care and public health, and has now become culturally entrenched as the American way. The political drive to change the current system to one based on primary care is slow, but gaining momentum. The recent passage of the ACA, which has many pro-primary care components, is a testament that there is a current movement towards reinvigorating primary care as the backbone to an improved health care system.
The movement towards improved primary care is currently hampered by several reasons including culture institutions, historical preference, and a cultural attitude for science and progress. Another reason for the slowness in this change is that the level of political power of primary care physicians is relatively weak compared to specialists. Political “power” can be defined in many ways, but this paper will approach power as “the capacity of persons or collectivities ‘to get things done’ effectively, in particular when their goals are obstructed by some kind of human resistance or opposition.” (Parsons, 1963)
This type of power is difficult to measure directly, so often outcomes of power are monitored. The outcomes of weak primary care power are presently seen in many areas: including reimbursements rates, national leadership in organized medicine, physician salary, administrative standing in academic health centers and schools of medicine, medical residency choice of students, lobbying money and power. While all of these areas are important, this paper will focus on reimbursements rates as one measurement of political power.
Education is the Solution
There are several possible solutions to improve the power of primary care physicians and, therefore, move towards an improved health system. There have been specific issues, which galvanize primary care physicians to make change, and using one of the key issues to mobilize would be possible. These times, however, are usually short-lived and fizzle when the issue is no longer center-stage. A deeper and more essential way to support change would be to start with changes to the early education of medical students, residents, and young physicians about the importance of these issues on their patients, their salary, and the health care system.
Primary care physicians are not as politically powerful, as compared to specialist physicians as measured by the reimbursement rate process. This lack of power has slowed the progress in improving the American health care system. The solution must focus on changing the culture of medical education. Medical students should proceed through medical school understanding the importance of primary care. In addition students, residents, and physicians should also have training in the areas of political science and politics, economics, leadership, and advocacy.