Primary health care began after the Alma-Ata international conference in 1978. The Alma-Ata Conference was an international conference in which government leaders worldwide came together to discuss health care problems and concerns. The fundaments of primary health care include four components: universal coverage, people-centered care, inclusive leadership and health in all policies.
Many supporters of primary health care point to the cost effectiveness of the system as an advantage, but there is some debate. Advocates believe that the hospital should not be a patient’s usual initial resort—rather, the patient should seek out a primary care doctor who can refer him to a specialist if needed. This would save initial costs for a consumer because a general primary care physician would be cheaper than a trip to the hospital, thus making the system more cost effective.
However, this would require a shift of care from a focus on specialists to emphasis on general practices and secondary-primary care. This restructuring of the system may mean that it would not necessarily be cost effective because of the costs it would require to make the switch. For example, according to numerous sources (including the New York Times and PBS) more doctors are choosing to become specialists in the United States, as opposed to primary-care physicians, because specialists are paid more on average 2.
To correct this problem, the government may have to finance more residency slots through Medicaid expenses. Additionally, salaries for primary-care physicians may have to be subsidized through Medicaid and other similar programs. This may make the program less cost effective as a whole.
- Many supporters of primary health care point to the cost effectiveness of the system as an advantage, but there is some debate.
- However, this would require a shift of care from a focus on specialists to emphasis on general practices and secondary-primary care.
High Patient Satisfaction
Ethical Implications of Medical Necessity
Supporters of primary health care identify high patient satisfaction as an advantage of the system. The ease of access to a doctor is a determining factor.
Despite the higher patient satisfaction that accompanies the primary health care system, opponents highlight the fact that the system disproportionately favors the poor over the middle class and rich. Because there is more investment in primary care versus hospitals, the individuals who receive the most benefit from the system are those with lower mortality and morbidity.
- Supporters of primary health care identify high patient satisfaction as an advantage of the system.
- Despite the higher patient satisfaction that accompanies the primary health care system, opponents highlight the fact that the system disproportionately favors the poor over the middle class and rich.
Advocates of primary health care also cite studies that show countries that use primary health systems have better health in the country as a whole.
Even after the variables were accounted for, the results clearly showed that better health can be achieved through a primary care system.
Opponents identify the fact that defining “primary care” is incredibly difficult. Each country has a different idea exactly of what “primary care” entails. Thus, for larger countries—such as the United States—it can be incredibly difficult to determine even exactly how to apply the general principles of the system to health care.
- Advocates of primary health care also cite studies that show countries that use primary health systems have better health in the country as a whole.
- Each country has a different idea exactly of what “primary care” entails.
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- New York Times: Doctor's No One Needs
- PBS.org: States Faces Shortages of Primary Care Doctors
- Palikuca S. 5 Things to know about direct primary care. American Osteopathic Association. March 13, 2019.
- Colorado Health Institute. Direct primary care: A new way to deliver health care. June 27, 2018.
- American Academy of Family Physicians. Direct primary care: An alternative practice model to the fee-for-service framework.
- Huff C. Direct primary care: Concierge care for the masses. Health Affairs. December 2015; Vol. 34, No. 12. doi:10.1377/hlthaff.2015.1281
- Hoff TJ. Direct primary care has limited benefits for doctors and patients. STAT News. September 6, 2018.
- Ramsey L. A new kind of doctor's office charges a monthly fee and doesn't take insurance — and it could be the future of medicine. Business Insider. March 19, 2017.
- Carlson K. Qliance closes after 10-year effort at new approach to basic medical care. The Seattle Times. May 17, 2017.
- Haefner M. 7 things to know about the rise of fee-based direct primary care. Becker's Hospital Review. March 19th, 2018
- American Academy of Family Physicians. The direct primary care model: How it works.
- Cornell Law School, Legal Information Institute. 42 U.S. Code § 18021(a)(1)(C)(3). Qualified health plan defined.
- Kona M, Lucia K, Corlette S. Direct primary care arrangements raise questions for state insurance regulators. The Commonwealth Fund. October 22, 2018.
- Internal Revenue Service. Publication 969 (2018), Health savings accounts and other tax-favored health plans: Other health coverage.
- Trump, Donald J. The White House. Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. June 24, 2019.
- Bliss G. An open letter to Congress from Garrison Bliss, MD. Direct Primary Care Coalition. October 30, 2019.
- Wu WN, Bliss G, Bliss EB, Green LA. A direct primary care medical home: The Qliance experience. Health Affairs. May 2010, Volume 29, Number 5. doi:10.1377/hlthaff.2010.0047
Alexis Writing has many years of freelance writing experience. She has written for a variety of online destinations, including Peternity.com. She holds a Bachelor of Arts in communication from the University of Rochester.