The problem with lack of emphasis on primary care in healthcarePrimary care physicians expressed little surprise at the findings of a recent Commonwealth Fund report that determined the United States spends more than any other high-income country on healthcare, yet it has the widest gaps in the quality of the care received.
The countries that have the best outcomes on the Commonwealth Fund list—in particular, the United Kingdom, Australia, and the Netherlands—achieve their high results scores by emphasizing primary care, said Jeffrey Gold, MD, head of Gold Direct Care in Marblehead, Mass. Gold’s practice has moved to the direct care model—eliminating the insurance companies and taking a monthly fee from each patient or family for a substantial menu of routine care.
“In the U.S., primary care is nothing more than an assembly line,” he said. “I had to see twenty to twenty-five people a day, and then spend a third of my day coding. The patients were getting eight minutes with me if they were lucky. That’s why I got out. We should stop insuring primary care, and start ensuring that everyone has good primary care.”
Risheet Patel, MD, a direct primary care physician who leads Fishers Direct Family Care in Fishers, Ind., pointed to the lack of focus on primary care in the United States as one of the most important reasons for the gaps.
“When looking at metrics like percentage of primary care providers in the workforce, primary care visits, or dollars spent on primary care, the US falls behind other countries,” he said. “If we want to change the direction of our healthcare system, we need to put more emphasis on primary care along with screening and prevention as opposed to costly testing and treatments.”
The insurance-based healthcare system rewards physicians for ordering tests, treatments, medications, and office visits, driving up the cost of care, he said.
“It’s often hard to get insurance plans to cover preventative counseling, smoking cessation, or weight loss programs,” said Patel. “If we can work to prevent disease progression, we can help reduce the burdens of testing and treatment. However, there is a definite lack of focus in this area.”
The concept that coverage equals care is a fallacy, Gold said. “Coverage and care are two completely different entities. Here in Massachusetts, the focus has been on getting everyone covered, but if you have someone on MassHealth and they’re living on a park bench, their outcomes are not going to be very good.”
Patel has also moved his practice to direct care.
“I am able to put the emphasis back on screening and prevention,” he said. “As we see patients in our office, we have adequate time to talk about lifestyle and prevention of disease, not just treatment. I am less concerned about needing to order more tests or do more procedures to help the bottom line. It has made practicing medicine more rewarding and has made our practice more attractive to patients.”
One of the reasons for the high costs and low outcomes in the United Sates is the emphasis placed on specialties rather than primary care, said C. Nicole Swiner, MD, whose family practice is in Durham, NC. “We end up spending and wasting money because people don’t go to their family doctor,” she said. “You spend money in the amount of procedures that are done and surgeries that are performed.”
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Θέμα: Is Primary Care essential ? (Αναγνώστηκε 22943 φορές)
18 Δεκεμβρίου 2013, 10:20:35