Universal coverage – doomed without more primary care

31 Oct
2008

 

Primary care shortage dooms universal health care

Primary care doctors spend more time talking with patients and managing health care without expensive procedures and tests. The reimbursement for these cognitive services are not keeping up with the costs of running a practice and young doctors are walking away from this type of practice in favor of better lifestyles and more pay.

Even in medical strongholds like Boston, Mass., where there are several academic teaching hospitals and wonderful medical care, there is such a shortage of primary care physicians that doctors and nurses can’t find a doctor to care for their own family. Finding a good primary care physician requires "knowing someone" who can open the door for you to be seen as a patient.

The proposal to provide insurance for the 45 million Americans who are presently uninsured will fall flat unless we address this critical issue of primary care and who is going to take care of people. Having insurance is not the same as having access to care.

Episodic, expensive, high-tech, specialty services have created a monetary health crisis that looms larger than the banking meltdown. It is time we look at the primary care crisis and begin finding solutions that will allow health care reform to succeed. Without considering the primary care piece, it is doomed to failure.

This from the ACP Internist blog.  Believe me, the ACP leadership understands this problem.  If we have movement towards universal health care, we must link this to improving the working conditions for outpatient adult medicine (both internists and family physicians.)

 See also the ACP Advocacy blog – The big issues the candidates are not addressing: Access to primary care

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Related posts:

  1. Universal health care will require fair pay for primary care
  2. Dazed and Confused – Levels of primary care?
  3. Why health care reform should focus on primary care
  4. Primary care – money is the answer
  5. One way universal coverage can save costs

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3 Responses to Universal coverage – doomed without more primary care

Avatar

Dr. Bob (FP)

October 31st, 2008 at 9:31 am

I was in Baltimore for a few weeks in January. I talked with a couple Johns Hopkins professors with the same problem. They had great health insurance & worked at Hopkins, but were having a hard time finding a primary care doctor. What a screwy system where you can work at some of the best medical centers in the world, but you can’t find a PCP to take care of you.

Avatar

Albert Fuchs

November 2nd, 2008 at 7:44 pm

DB: But you’re a Thomas Sowell fan, so you should know that universal coverage is doomed with or without more primary care.

Dr. Bob: We too frequently confuse insurance with care. Lots of people have insurance and can’t find care. Our goal shouldn’t be universal insurance, it should be increasingly excellent and afordable care. That can only happen with less gov’t spending on healtcare, not more.

Avatar

Dr. Bob (FP)

November 5th, 2008 at 3:03 pm

I agree Albert. In Massachusetts they’re all getting insurance, but can’t get care. Simply giving everyone Medicaid who can’t afford insurance doesn’t solve the problem if there is no one to care for them. Both having health insurance and having a primary doctor are independent predictors of quality, mortality, etc. What often is missed in the health care debate is that just giving people health insurance does not solve the problem. They need a PCP as well, but there will be fewer and fewer if nothing changes.

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