Primary care in the United States in crisis

Primary care is in crisis especially as changes occur in the United States population and in the financing and organization of the health care system, according to a series of reports led by a UCSF research team.

In a special supplement in the February 4, 2003 issue of The Annals of Internal Medicine, leaders in primary care urge a concerted, national effort to reconstruct primary care in order to care for our increasingly older, chronically ill, and diverse population. The supplement was funded by The Robert Wood Johnson Foundation.

According to the researchers, primary care is a vital component of high quality health care -- its strengths deriving from its continuous relationship with patients, its broad perspective, and its flexibility and adaptability. Yet, there are new and substantial threats to primary care.

"Primary care is a core component of nearly all modern health care systems in the world except in the United States," said Jonathan Showstack, PhD, MPH, UCSF professor of medicine and health policy and lead author of the report. "If we don't reconstruct the way that primary care is provided, we will inevitably face a very costly medical, financial, and human crisis."

While patients value primary care, a host of organizational and financial pressures now impinge on primary care's viability, according to Steven A. Schroeder, MD, UCSF distinguished professor of health and health care and co-author of a report in the series.

As a result, patients are increasingly dissatisfied with their relationships with their primary care physicians, according to the researchers. Access to primary care services is becoming much more difficult, even for those with insurance. In addition, primary care providers are finding it more difficult to respond to patients' needs for accessible, comprehensive care, they said.

"The role of 'gatekeeper' has tarnished the image of the primary care physician," explained Showstack. "Prima

Contact: Maureen McInaney
University of California - San Francisco

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