The U.S. must bolster primary care and connect more Americans with a dedicated source of care, the National Academies of Sciences, Engineering and Medicine warns in a report that sounds the alarm about an endangered foundation of U.S. health care.
The report, which comes as internists, family doctors and pediatricians struggle with the economic fallout of the pandemic, calls for recognition that primary care is a “common good” akin to public education.
The authors recommend all Americans select a PCP or be assigned one, a step that could reorient how care is delivered in the nation’s medical system.
And the report calls on health plans such as Medicare and Medicaid to shift money to primary care and away from specialties that command the biggest fees in the U.S. system.
“High-quality primary care is the foundation of a robust health care system, and, perhaps more importantly, it is the essential element for improving the health of the U.S. population,” the report concludes. “Yet, in large part because of chronic underinvestment, primary care in the United States is slowly dying.”
The advisory report doesn’t guarantee action, but reports from the academies have helped support initiatives over the years such as curbing tobacco use among children and protecting patients from health care errors.
Strengthening primary care has long been seen as a health need, and research dating back more than half a century shows robust primary care systems save money, improve people’s health and save lives.
“We know that better access to primary care leads to more timely identification of problems, better management of chronic disease and better coordination of care,” said Melinda Abrams, executive vice president of Commonwealth Fund, a New York-based foundation that studies health systems around the world.
Recognizing the value of this care, many nations have constructed health systems around primary care, and many have reaped rewards. Europeans with chronic illnesses such as diabetes, high blood pressure, cancer and depression reported better health if they live in a country with primary care.
For decades, experts here have called for a similar commitment. But only about 5% of U.S. health care spending goes to primary care versus 14% in other wealthy nations, according to the Organization for Economic Co-Operation and Development.
Other research shows primary spending has declined in many U.S. states in recent years. The situation grew more dire as the pandemic forced thousands of primary care physicians – who didn’t receive the government largesse showered on medical systems – to lay off staff members or close their doors.
Reversing this slide will require new investment, the authors of the new report conclude. But, they argue, that should yield big dividends.
“If we increase the supply of primary care, more people and more communities will be healthier, and no other part of health care can make this claim,” said Dr. Robert Phillips, a family physician who co-chaired the committee that produced the report. Phillips also directs the Center for Professionalism and Value in Health Care at the American Board of Family Medicine.
The report urges new initiatives to build more health centers, especially in underserved areas that are frequently home to minority communities, and to expand primary care teams, including nurse practitioners, pharmacists and mental health specialists.
And it advocates new efforts to shift away from paying physicians for every patient visit, a system that critics have long argued doesn’t incentivize doctors to keep patients healthy.
Potentially most controversial, however, is the report’s recommendation that Medicare and Medicaid, as well as commercial insurers and employers that provide their workers with health benefits, ask their members to declare a primary care provider. Anyone who does not, the report notes, should be assigned a provider.
“Successfully implementing high-quality primary care means everyone should have access to the ‘sustained relationships’ primary care offers,” the report notes.
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