Medicine
As the U.S. Senate inches closer to passing its version of a health reform bill, general internist Thomas Bodenheimer and colleagues from the University of California, San Francisco argue convincingly in the December issue of the Journal of Family Practice that expanding health insurance coverage without expanding of primary care capacity will not lead to improved health outcomes. In addition to a shrinking supply of family physicians, they identify eight additional "barriers" to patients accessing primary care services that must be addressed if health reform is to achieve its potential:
1) Panel size - family physicians, especially those in rural locations, are caring for more patients than they can effectively manage.
2) Capacity - shorter visit times necessitated by large patient panels negatively affect care quality.
3) Distance - many patients live too far from the nearest family physician to access regular primary care.
4) Medicaid/Medicare issues - Medicaid and Medicare fees are often considerably lower than those of private insurers, in some cases, paying physicians less than the actual cost of providing services. Consequently, many practices limit the number of patients with these types of insurances that they accept.
5) After-hours care - is often unavailable.
6) Scheduling - most practices are unable to schedule timely (same day or next day) appointments for non-acute issues.
7) Virtual visits - insurers do not pay for patient encounters via telephone or e-mail, leading to missed opportunities or unnecessary office visits for equivalent services.
8) Troubles with team care - although registered nurses, pharmacists, medical assistants, and other allied health workers that can be trained to perform routine medical tasks and free up physician time, most insurers do not acknowledge (or pay for) non-physician services.
There is no single solution to all of these issues, nor will every solution be right for every practice or every community. But the recent experience of Massachusetts in providing universal health insurance coverage tells us that making primary care more affordable will not make it more accessible; in fact, it is likely to do the opposite. As Dr. Bodenheimer and colleagues conclude, "Unless Americans have greater access to primary care, we fear, the U.S. health care system will undergo significant change without substantial improvement." Regardless of whether a health reform bill passes Congress before Christmas, policymakers must understand that they remain very far from the finish line.
- When Is The Doctor Not Needed? And Who Should Take Their Place?
A lengthy editorial in the New York Times, December 16, 2012, "When the doctor is not needed”, discusses how a variety of other health professionals can help to meet the health care needs of the American people when there are not enough physicians....
- Primary Care: What Takes So Much Time? And How Are We Paying For It?
. In a piece that has gotten a lot of attention, “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice”(New England Journal of Medicine, Apr29,2010;362(17):1632-6), Philadelphia general internist Richard J. Baron writes about...
- Let's Get Creative In How We Provide Health Care To The Poor
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled...
- Tackling The Problem Of Too Few Family Physicians
Researchers at the American Academy of Family Physicians' Robert Graham Center have estimated that the U.S. will require 52,000 additional primary care physicians by 2025 due to the effects of population growth, aging, and insurance expansion....
- The "single Payer" Should Be You
When some people say that the U.S. should have a "single payer" health care system, they're generally talking about a system in which government is the exclusive payer of all health care bills. It's tempting to think that in such a system, the...
Medicine
"The health care problem no one's talking about"
As the U.S. Senate inches closer to passing its version of a health reform bill, general internist Thomas Bodenheimer and colleagues from the University of California, San Francisco argue convincingly in the December issue of the Journal of Family Practice that expanding health insurance coverage without expanding of primary care capacity will not lead to improved health outcomes. In addition to a shrinking supply of family physicians, they identify eight additional "barriers" to patients accessing primary care services that must be addressed if health reform is to achieve its potential:
1) Panel size - family physicians, especially those in rural locations, are caring for more patients than they can effectively manage.
2) Capacity - shorter visit times necessitated by large patient panels negatively affect care quality.
3) Distance - many patients live too far from the nearest family physician to access regular primary care.
4) Medicaid/Medicare issues - Medicaid and Medicare fees are often considerably lower than those of private insurers, in some cases, paying physicians less than the actual cost of providing services. Consequently, many practices limit the number of patients with these types of insurances that they accept.
5) After-hours care - is often unavailable.
6) Scheduling - most practices are unable to schedule timely (same day or next day) appointments for non-acute issues.
7) Virtual visits - insurers do not pay for patient encounters via telephone or e-mail, leading to missed opportunities or unnecessary office visits for equivalent services.
8) Troubles with team care - although registered nurses, pharmacists, medical assistants, and other allied health workers that can be trained to perform routine medical tasks and free up physician time, most insurers do not acknowledge (or pay for) non-physician services.
There is no single solution to all of these issues, nor will every solution be right for every practice or every community. But the recent experience of Massachusetts in providing universal health insurance coverage tells us that making primary care more affordable will not make it more accessible; in fact, it is likely to do the opposite. As Dr. Bodenheimer and colleagues conclude, "Unless Americans have greater access to primary care, we fear, the U.S. health care system will undergo significant change without substantial improvement." Regardless of whether a health reform bill passes Congress before Christmas, policymakers must understand that they remain very far from the finish line.
- When Is The Doctor Not Needed? And Who Should Take Their Place?
A lengthy editorial in the New York Times, December 16, 2012, "When the doctor is not needed”, discusses how a variety of other health professionals can help to meet the health care needs of the American people when there are not enough physicians....
- Primary Care: What Takes So Much Time? And How Are We Paying For It?
. In a piece that has gotten a lot of attention, “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice”(New England Journal of Medicine, Apr29,2010;362(17):1632-6), Philadelphia general internist Richard J. Baron writes about...
- Let's Get Creative In How We Provide Health Care To The Poor
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled...
- Tackling The Problem Of Too Few Family Physicians
Researchers at the American Academy of Family Physicians' Robert Graham Center have estimated that the U.S. will require 52,000 additional primary care physicians by 2025 due to the effects of population growth, aging, and insurance expansion....
- The "single Payer" Should Be You
When some people say that the U.S. should have a "single payer" health care system, they're generally talking about a system in which government is the exclusive payer of all health care bills. It's tempting to think that in such a system, the...