A new brief from The Commonwealth Fund explores the American disconnect from primary medical care. The metrics place the US near the bottom of the 11 high-income countries surveyed.
The Commonwealth Fund is a private foundation founded by Anna Harkness in 1918. Ms. Harkness was a philanthropist deeply interested in healthcare improvement. She and her family bestowed millions on the foundation and other educational interests. Today, the Commonwealth Fund supports research and provides grants to address healthcare policy and practice, as well as research to stimulate innovation through awareness of international health policy.
Recently, The Commonwealth Fund released a comparison detailing patient access to primary health care and services in the US. The evaluation compares the US with other countries including Germany, Canada, Norway, Australia, Sweden, France, the Netherlands, and the United Kingdom.
The report notes that “decades of underinvestment and a low provider supply, among other problems, have limited access to effective primary care.” Some of the findings include:
- Access: Of the countries surveyed, only Sweden ranks lower than the US for regular patient access to a primary care physician, or routine access to a treating clinic. Part of the reason for the ranking is that the US has a lower number of primary care physicians.
- Continuity: Continuity of care ensures a patient receives higher quality, safer, medical care over time in collaboration with a care team. This can take the form of a long-term relationship with a primary care provider (PCP). The US ranks last for continuity of care. Patients who have a regular PCP are less likely to use Emergency Departments and are more likely to receive care for chronic conditions over time.
- Home visits and after-hours appointments: Again, the US ranks a considerable last on this metric. PCPs in the US are less likely to provide home visits to patients than all other counties. While a lack of providers contributes to the problem, the basic infrastructure for training and time for PCPs to make house calls in the US is lacking. Additionally, the US ranks last in providing after-hour patient visits (excluding Emergency Department service).
- Screening for social needs: The US ranks first among the comparison countries for screening for needs including food security, housing, basic needs, and exposure to domestic violence. However, the finding may point to well-subsidized social services in other countries, funding of which is wholly lacking in the US.
- ED reports to PCPs: The US is at the midline of countries for whom PCPs are notified when a patient has been seen in the ED. Notification of a PCP about an ED visit assists with continuity of care after an ED event, among other benefits.
The report suggests ways in which the US could better meet its healthcare needs, including:
- Create incentives for medical students to pursue a career as a PCP, including reducing the wage gap between specialists and general physicians.
- Improve infrastructure to increase access to telemedicine
- Hold providers responsible for continuity of care by expanding reforms for payment of services
- Adequately fund social service programs to reduce worry by American patients about their basic social needs
The report points to the inadequacy of the healthcare safety net in the US and how funding, recognition, and physician education could improve the experience of healthcare consumers in this country. In the currently polarized environment of the US, it is not likely great strides will be seen on these issues anytime soon.
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