Proponents of health reform have long claimed that one of the biggest problems with our health care system is an overemphasis on expensive specialists and an underemphasis on primary care physicians — who, much research shows, produce high quality care at a much lower cost.
In essence, the argument is that we’re using (and paying for) rocket scientists to fly kites. If we bolster the primary care workforce, suddenly we’ll start saving buckets of cash and people will not only be just as healthy–but they might actually start becoming healthier, as greater emphasis is placed on things like prevention, continuity of care, and chronic disease management.
To be fair, not every study supports the “more primary care is better” philosophy, but that hasn’t much mattered. It has become a central tenet of reform for most. Tom Ricketts and I actually authored a paper that raises some methodological concerns, which call some of the typical findings into question.
But the most recent kicker comes from the folks at the Dartmouth Atlas who are well known for their work revealing the wide geographic variation in Medicare spending. The group recently released a report that, simply put, says primary care isn’t the panacea many people claim it to be.
What in the world is one to make of this? Nothing really. Primary care practices don’t exist in a vacuum. People’s environments, their lifestyle choices and health behaviors still play a large role in their health outcomes. Furthermore, patients rely on both generalists and specialists, not generalists alone.
The Dartmouth report doesn’t mean that primary care is suddenly more expensive than previously thought, or that it doesn’t provide the high quality of care it was once believed to. Rather, it means that there is no “magic bullet” that will suddenly solve all that ails our country’s health care system.
Let me be as clear as possible about this: Primary care is a good thing — it’s just not the only thing.
Brad Wright is a health policy doctoral student who blogs at Wright on Health.
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