The United States is the only industrialized country in the world that does not have a governmental program to assure financial access to health care services to all of its people. In fact, the health of the U.S. population is far from being the best in the world. In the rankings of the major health indicators for the major industrialized countries, the United States ranks last or near last on most documented reports.
It is not only having health insurance that influences the likelihood of good health, but the quality of services that are available to people also counts. Most people think that having free access to high-powered specialists assures them the best quality of care. For most this is not the case. Although access to specialist s is very important for those people who need it, unrestrained access to specialists for people who think they might need it is potentially dangerous, leading to unnecessary and potentially dangerous tests and therapies. This is why the linkage of people with a strong primary care practitioner is important.
Primary care doesn't only mean having a certain kind of physician as one's regular source of care. It means having a doctor who functions in certain ways. This means providing access to services that people seek care from that doctor whenever they have a new need for care or preventive services. It means having a strong relationship with that doctor, that the doctor understands people's needs and people feel comfortable telling the doctor about those needs. It means providing care for ALL needs that are common in the population and referring to specialists when the problem is too unusual or uncommon for the primary care practitioner to manage. It also means coordinating care so that when people do have to be referred elsewhere, the advice received is integrated into total care so that there are no conflicting recommendations that could cause harm.
Barbara Starfielf, MD, Mph is a University Distinguished Service Professor with appointments in the Department of Health Policy and Management and Pediatrics at the Johns Hopkins University Schools of Public Health and Medicine. In her book, Is Primary Care Essential?, she cites six strategies that may help consumers receive the care to which they are entitled.
- The most important thing for consumers is to have a doctor in whom they have confidence. Optimally, people should strive to keep the same doctor for at least 2-5 years, in order to allow enough time to build a strong relationship. When doctors know patients well, diagnosis can be more efficient.
- The issue of free access to specialists takes second place when there is confidence with the primary care doctor. When doctors and patients know each other well, they are much more likely to understand what other care is needed and come to mutually agreeable decisions about where that cares should be sought.
- The reason why the consumer movement has been interested in having free choice of specialists is because the primary care system in the United States has been weak. A better strategy is to work towards a system in which there is free choice of primary care providers, and in which employers or other third parties are not allowed to disrupt these relationships when new insurance contracts are arranged.
- Consumers, through their purchasing power and through their political representatives, should insist on a benefit packaged that gives their primary care providers the ability to provide the full range of primary care services, rather than having patients go elsewhere for certain types of problems. The best care is provided when the primary care practitioner takes responsibility for assuring the best possible outcome of care including seeking consultation and referring when that care is deemed best through patient and doctor agreement.
- Patients have a right to see their medical records, to keep a copy, and to clarify or correct errors in it. This will not only improve patients' knowledge about their care but it also will encourage practitioners to record things that are of importance to the care of the patients.
- People should insist that their health providers, both primary care and specialists, become involved in efforts to continually assess what they do and what they accomplish for their population of patients.