Is inappropriate primary care the problem with US health care?

[Guest guest]

No need to speculate on this topic, there are volumes of publications on

this issue. I present one of the most recent - not as the

be-all-and-end-all of publications, but merely as a reflection of a wealth

of data.

Parts of the US with greater concentrations of PCP per capita have better

satisfaction, better health outcomes, lower total cost.

Parts of the US with greater concentrations of specialty care and hospital

beds have worse satisfaction, worse outcomes and higher total cost.

The reasons are explained in the attached..

Does this mean primary care is pristine and we only need more of us around?

Not for a second. There are certainly times when PCPs order inappropriate

tests and treatments, there good studies documenting the inadequate levels

of care delivered by PCPs in the US. This is an unfortunate consequence of

being put in the professional equivalent of Lucille Ball on the assembly

line in the candy factory.

The current system is perfectly designed to get us these woeful results:

inadequate resources, low fee-for-service pay for visits and no remuneration

for all the other work of primary care, the unfunded mandate of the insane

administrative trivia game (billing, prior auth, and forms from here to our

collective grave). In general we are on a diabolical treadmill and unable

to live up to our professional obligations.

We can work to put our houses in order, to use the best medical information

to support our patients, to provide superb access, excellent continuity, a

broad array of service, and coordinate care across the continuum when we are

adequately resourced to do the work and we lose the crushing yoke of

administrative trivial pursuit.

High performing health systems are founded on effective primary care. Give

us the resources and relief we need to do our work.

G