The country’s huge investment in technology has not yet targeted the primary care setting, perhaps because the people directing those funds believe that technology and primary care are antithetical instead of complimentary. Indeed, many working in primary care now recognize that information management technologies are integral to robust primary care, but the cost of information systems capable of defining populations under care, monitoring their health status, measuring results, and improving quality are far beyond the resources available for primary care. Many of the procedures known to relieve suffering and improve the probability of staying healthy are performed competently in primary care but have not been widely implemented because of disorganization and perverse financial arrangements. Breakthrough technologies for teaching, such as virtual reality training centers, could make primary care training more efficient, but financial requirements exceed the revenue-generating capacity of primary care.
This pervasive lack of funding for primary care is one explanation for why it is a relatively powerless, awaiting its full manifestation as the foundation of an affordable and effective health care system.
Universal Health Coverage
Universal coverage—the inclusion of all people in the primary care system—has emerged as a major issue for those attempting to achieve the best primary care for our country. Accompanying a belief in this policy is a disbelief that the United States has the political will to do what is necessary to implement such coverage. Its affordability is doubted, but some policymakers suggest that primary care is an essential part of a sustainable inclusive solution. Indeed, as medicine and society create each other, universal coverage and primary care are also interdependent.
Because it is situated between the community and the rest of medicine, primary care is exposed to a broad spectrum of patients’ troubles and aspirations. When segments of the community are explicitly or functionally excluded, they are disadvantaged by not having access to the benefits of primary care, and they often eventually need to rely on health care and social services that may be inappropriate, too expensive, or too late. Not only are the excluded individuals disadvantaged, but so are their neighbors who experience less obvious losses and risks because of the neglect of significant numbers of their cohabitants.
Primary care provides a sensible link between individuals in the community and medical care. The ability to put primary care into practice, however, is compromised in the United States because of distortions and distractions created by selective inclusion. Without commitment to universal coverage, the value of primary care erodes, and the return on investment seems to diminish. To fully realize the benefits of primary care, universal coverage is necessary.
Preliminary plan of action
These themes provide a framework but not the focused explicit plan of action that is needed. To stay focused will be a continuing challenge for those seeking to bring a family practice and primary care perspective to health policy. To face this challenge, the Center initially will pursue the following 5 objectives.
Facilitate cooperative relationships with others interested in health policy. There is a vibrant health policy community in Washington, but it lacks a critical mass of primary care advocates. The initial strategies will include personal visits with various individuals and organizations, the establishment of an advisory board, an open house for the new Center, and an ongoing primary care forum in Washington for those interested in primary care health policy.
Develop mechanisms to communicate ideas about primary care. The Center will establish a Web site and and publish 1-page reports as ongoing methods for engaging others and reporting its work. The AAFP’s publications will be used to disseminate information when appropriate. Results of specific studies will be submitted to relevant journals. Occasionally, the Center will author a monograph focused on an issue of particular importance to family practice and primary care. Members of the Center will present ideas at selected meetings and in response to invited commentary.
Create a capacity to evaluate contemporary health policy issues from a family practice and primary care perspective. The time frame for policy issues ranges from moments to years. Sometimes, relatively immediate information is necessary for evidence-based advocacy. The Center will acquire and link multiple data sets to create a capacity to evaluate issues in short time frames using existing data. Cooperative relationships with other research centers and specific individuals will be explored. A catalog detailing useful data sets will be assembled. A rotating internship program will be tested, with interns functioning as essential members of the Center’s team. The topics evaluated will depend on the current issues that concern family practice and primary care.