Saving Primary Care | Effective Primary Care

Other developed countries outperform the US by a wide margin on multiple measures of population health. This is accomplished with per capita health spending less than half that of the US.ⁱ In numerous publications Barbara Starfield and colleagues demonstrate the links between high performance/low cost and the presence of fundamental attributes of primary care.ⁱⁱ Countries with health systems founded on effective primary care have lower health care costs, better population health outcomes, and better experience of care than the US.ⁱⁱⁱ Regions of the US with greater proportion of primary care providers to the population have better health outcomes and lower health care costs than regions served by a lower proportion of primary care providers to the population. ^iv

What is it about primary care that leads to these results? Decades of literature identify ease of access, a solid relationship built over time, a broad array of services, and coordination of care as the key attributes of primary care.^v

These attributes can be measured by asking patients about their experience of care.^vi When people experience waits and delays for an appointment or wasted time in the office setting they are less likely to show up for needed care.^vii People who have a regular provider, have no difficulty contacting them, and report well organized and on-time office visits are more likely to receive preventive care reminders, to be better prepared to manage their chronic conditions and to achieve better outcomes.^viii

When people experience an eroded relationship with their doctor they are less likely to follow through on recommended preventive care.^ix People who can identify one individual as their personal doctor or health care provider are more likely to have had colorectal cancer testing.^x People who don’t know who is in charge of their care are more likely to end up in the emergency room or hospital.^xi Medicaid recipients are more likely to be hospitalized if they experience poor provider continuity.^xii Patients can clearly identify coordination versus fragmentation of care: they also notice the beneficial effects of coordination.^xiii

Patient experience with the fundamental attributes of primary care can be measured and reported. People who receive care in practices that deliver effective primary care have better health outcomes and don’t end up in the Emergency Room or hospital as much.^xiv

If effective primary care was rewarded on the basis of coordination of care and quality, not punished by being paid by volume as if our patients were boxes of goods, effective primary care would flourish and health care would cost a lot less.