Not only is the access and availability of needed services important in outpatient care, but also the quality of care received is an absolute priority for citizens of the system. Decades of research have shown that good primary care reduces costs and improves outcomes, yet we have ignored these fundamental facts to our detriment. I will discuss our current quality of primary care in the United States and the reform we propose for our ideal universal health care system.
One of the first problems with our current primary care is the lack of family practitioners throughout the US. This causes increased stress on the clinician to see as many patients as possible, resulting in quick and inefficient visits. “In the United States, approximately 40.8 percent of the physicians work in primary care and the remaining 59.2 percent are specialists, according to 2003 data from the American Medical Association (US Bureau of Labor Statistics 2007).”
“The number of positions filled in family practice residency programs showed an increase during the first few years of the 1990s, but there has been a slow decline since 1998” (Shi, Singh, 133).
This is a very different ratio as compared to other industrialized countries where only about 25 to 50 percent of physicians are specialists (Shi, Singh, 134). Utilizing more specialty services usually includes the most up-to-date technology and services which results in higher expenses.
The need to change this unequal balance is very clear. To do this, we propose an incentive for medical schools to encourage students to practice in the field of primary care. This would be accomplished through increased financial awards and funds towards tuition and also towards schools whose curriculum incorporates concern and training in the areas of outpatient care.
Another way to increase the number of primary care doctors would be to offer a sign-on bonus for those who commit a minimum number of years as a primary doctor before pursuing specialization, if desired. If we had a universal system, these funds would come from the government.
A second problem related to the quality of primary care is the lack of education offered to patients and the over-utilization of ‘doctor’s visits.’ Our country has been so focused on the supply side of health care that the demand side has been ignored. What does this mean? Well, instead of putting all of the focus into the control of services, cost, technology, and other health care supplies, what about putting more effort into decreasing the demand for care.
A piece from a health care reform proposal entitled, ‘Beyond Health Promotion: Reducing Need and Demand for Medical Care, aligns well with the idea that reducing demand for care is ideal. It suggests that “an integrated system of population-based health care delivery would join the tenets of health promotion—self-efficacy, behavior modification, and long-term management of health and disease—with traditional approaches to diagnosis, treatment, and prevention” (Healthaffairs.org, 1).
One way to reduce the demand for care is to provide health education to patients and to promote personal involvement in their health and well-being. This can be done in many ways, two of which we will focus on. The first, is to utilize the vast amount of technological resources available. “E-health refers to all forms of electronic health care delivered over the Internet, ranging from informational, educational, and commercial products to direct services offered by professionals, nonprofessionals, businesses, or consumers themselves” (Shi and Singh, 166).
The amount of time and effort it takes to actually get into a clinic can be minimized or eliminated through email or other educational tools sent via the Internet between doctor and patient. This of course would not be right for every patient, but could definitely be utilized by those who have access to these types of technologies and in events where simple questions and other services can be relayed in this manner. Examples of the efficient use of E-health could include the sending of updates on blood pressures for a patient on a new medication, or for a young diabetic patient to ask a quick question concerning his/her new pump.
Another way to increase education and reduce the dependency on physicians would be to incorporate health educators into clinics and other health care facilities throughout the United States. They would act as buffers before patients see a doctor and could take some of the load off of clinicians. Some of the services they could provide could be training on the use of certain medical devices patients receive to monitor their illnesses and conditions, to providing nutrition education and dietary guidance to newly diagnosed diabetic patients.
References:
Healthaffairs.org
(http://content.healthaffairs.org/cgi/reprint/17/2/70.pdf).
Delivering Health Care in America, Shi and Singh.
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Moving from a rural community to an urban area, I could tell a major difference between access to care. In the rural community, there were not that many family practitioners and it could be difficult to get in and see a doctor if you had a problem. I really like the idea of incorporating health educators into clinics and other places to help with educating patients and answering their questions. It can be hard to get in contact with a doctor to ask a question and sometimes they do not have time to answer all of your questions when you are there for a visit, and having the option of a health educator to explain things would be great.
ReplyDeleteI think it is important to help educate patients to help to take the work load off of doctors. I also agree that this will not work for everyone and seems to be more for patients with repetetive problems.
ReplyDeleteI do however disagree with the propossed processes to attain un-specialized doctors. If you give insentives to stay at a lower level there will be no reward for continuing education to become a specialist which are greatly important and needed. Also how is it that we would be able to afford these incentives? I greatly disagree with a national health care coverage so having the government pay these incentives is something that I do not agree with and something that our hospitals would not be able to afford and just increase the costs to patients. It is obvious that our system needs reconstruction-but the method for this reconstruction is probably the biggest problem.
I think that as Americans, we pursue secondary and tertiary treatment and put primary care on the back burner. Many are uneducated about their health, and do no take the preventative measures necessary to aviod the development of disease. I do agree that doctors are pushed more into specializing and that family practice is not held in such great esteem. For these reasons, we spend way more on healthcare than we would've needed to if primary care was our main concern. It is so much cheaper to prevent things, than to treat them after they happen. I do think that is an awesome idea to have additional health educators in the hospital who can show people how to properly take care of themselves. It is also a wonderful idea to offer incentives for doctors to enter into primary health care. However, the main problem is the whole idea about Health and Healthcare in the United States, and this perspective needs to start to change before we see any real strides.
ReplyDeleteI was very interested in your first idea to help fix the ratio of primary doctors and specialists which suggested offering grants and scholarships to students pursuing a career as a primary doctor. As a college student, I know first hand how much influence financial aid can make in many decisions of a students life- including choosing a major and college. I am confident that your idea will encourage more students to become primary doctors due to this fact.
ReplyDeleteI believe it is crucial for our healthcare system to focus on minimizing the demand for health care needs as opposed to our current focus on meeting supply needs as stated in the article. In order to make this happen education needs a primary focus for outpatient care. This may be difficult but in the long run our health care system will be a much healthier industry. I am a marketing and finance major and find that the majority of the health care industries problems come due to the overmarketing of medicines. Everywhere you look there is a new cure for something which is aggressivley pushed towards the american public. People are so quick to be dependant on a pill when a couple simple life changes could eliminate its necessity.
ReplyDeleteI think this is a very well thought out reform, and a much needed reform. I was talking the other day to a biology student here at UWL and he just got accepted to UW-Madison's Medical Program. I was surprised when I asked him what type of doctor he wanted to be and he said family practioner/primary care. He gave me many valid reasons why he was choosing the primary care field instead of going into a speciality.
ReplyDeleteWhat I found surprising in talking to him was that he said many times medical schools will push students toward becoming specialist. In a section of the program students do "rounds" at a hospital in which they work in several different areas of the hospital. They do this he said so that students can see which area they like the most, and then choose that to specialize in. Perhaps thats the reason students choose to specialize in a certain area rather than become a primary doctor.
I think its great that more funds and financial incentives could be rewarded for students choosing the primary care. Maybe their could be more scholarships awarded to these students, or other types of funding that will help them pay for medical school.
Overall a very well thought out reform!