Could primary care improve the
United States’ Healthcare System?
If you take a good look at healthcare publicity on the Internet, TV, billboards, and radio, you’ll notice that specialists are the ones that are featured the most. You’ll see advertisements on cancer centers, plastic surgeons, cardiologists, ophthalmologists… However, you’ll find out that there’s one element missing: Primary care.
You hardly see primary care billboards and commercials. Nevertheless, primary care is incredibly important for improving the healthcare system. Why? Because primary care can prevent emergency room visits and hospitalizations, which means a lesser total expenditure. Primary care providers allow better early detection and treatment of medical conditions and preventive care.
In most parts of the US, primary care spending doesn’t surpass 7 %, which is less than half than most Western European countries, where it’s usually around 12 % and 15 %.
That means that about 1 in every 4 Americans don’t have adequate access to primary care. And it’s getting worse. In 2015, there was an average of five primary care practitioners per 100k persons. By 2030 the shortage will rise to 150k. Also, considering that most physicians are concentrated in urban and suburban areas, the situation will be even worse in rural areas, where people are, on average, older, poorer, and sicker. The picture is bleak.
What is causing this issue? Three factors mainly: lack of residency slots; levels of student debt that leads professionals into seeking higher-grossing specialties; and the large salary gap between primary care and specialists.
And… that’s not it. There are significant administrative difficulties related to the requirements to sustain an electronic medical record-keeping: primary care doctors have to work two hours filling bureaucratic documents for every hour they work with their patients. Yes, you read that correctly.
What can be done for primary care physicians? It’s not easy. Some new payment model propositions promote value over volume but, in fact, may increase bureaucratic burdens and practicing costs for primary care professionals. Also, a successful transition into a value-based model requires an adequate infrastructure of data exchange and care coordination, which, usually, doesn’t exist.
However, that doesn’t mean everything is lost. But the first step is clear: it’s necessary to increase primary care reimbursements. The only way to improve access to primary care is by having more primary care practitioners, and the only way to have more primary care practitioners is reducing the pay gap between primary care and specialties.
There are other radical proposals. The Lown Institute, for example, proposed that the Federal Government could cover medical school costs for students who dedicate ten or more years of their careers to primary care. They also recommend changing the primary care model into one that doesn’t require insurers. Primary care physicians could charge a monthly fee to clients for their services that would include all primary care services, which is the case in many European countries.
The American healthcare system is a hot-button topic among public policy specialists. However, those specialized in healthcare, agree on one thing: Primary care is key to improving the system, and it’s not working as it is. A value-based approach that gives incentives to practitioners may be the way to go.