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Primary care is the foundation of an effective and efficient health system. The more robust a nation’s primary care service, the better are the health markers seen in the population and the lower the comparative cost of healthcare. In the USA, primary care has been under stress for some time, under-supported financially with too small a physician workforce, and over-taxed by demands to impact the population as a whole. The Institute of Medicine (IOM) and other health policy leaders have attempted to remedy the quality problems of the healthcare system by calling for a reorganization of primary care into a medical home that is patient-centered, evidence based, offering improved access, better ongoing contact, and coordination of care. The IOM’s ten rules for the redesign of healthcare include some that are focused on systems change in the delivery of care and others that are focused on relationship change of doctors and their patients. The systems change rules have been easier to implement. The improvements associated with the change of the relationship of the physician and healthcare team to the patient have not been nearly as impressive. Therefore, it is in this area that the next steps to a more equitable delivery of healthcare must take place. |
