Lancet article names primary care as the solution to the US Health Care System

There is national consensus that the US health care system is in a crisis and desperately needs reform. What is unclear is what reform is needed.

In this week's Lancet, Pugno et al. present primary care as the option that is both effective on health outcomes and cost efficient. The United States is the only developed nation that does not have universal access to comprehensive, continuous and preventive services in a primary-care-based system. The medical home model, used in other nations, has the ability to streamline health services and eliminate disparities in health care. Primary Care through the medical home model has been shown by multiple studies to have a positive effect on health outcomes and reduce mortality/morbidity. It is also much more cost effective than specialty-based care, which also contributes to higher mortality/morbidity in society.

Pugno et al. suggest that the key to health reform is promoting careers in primary care to meet the health care needs of the people. Concrete suggestions include:
1) Increase the attractiveness of careers in primary care: changing the payment method for primary care services and increase control over lifestyle
2) Prioritization of medical students' interests in primary-care careers that practice generalist approach to health care
3) Providing support for training programmes for primary-care physicians.

Providing universal health care is not a solution without primary care doctors to provide the services. Providing funding for programs like the National Health Service Corps and community health centers are a positive step but doctors are needed to fill the spaces in these programs. Ultimately, what we need to do is change the perception of primary care and increase the attractiveness of primary care to medical students.

Pugno, PA, Kellerman R, McGaha, AL, Kahn NB Jr. The solution to the US health-care crisis. Lancet. Published online November 3, 2008