Improving the health of our nation will apparently require more than just solving the primary care physician shortage and increasing access to primary care. A new Dartmouth Atlas report shows that a large number of primary care docs in a region does not necessarily mean that more people in the region are actually receiving primary care, and moreover, receiving primary care does not guarantee better outcomes for patients.
The study results were based on Medicare recipients, so everyone in the study was insured. This is a far cry from the general population, where about 16% (probably more now that the recession has taken its toll) of people over the age of 18 don’t have health insurance at all. But even in the universally-insured Medicare population that was studied, there was great variation from one region to another in terms of the care provided.
The study’s authors note that access to primary care is not in and of itself a problem solver. Yes, we have a shortage of primary care providers, and yes that shortage will probably become more pronounced as millions of newly insured people start seeking care over the next few years. But what we really need is coordination between primary care doctors, specialists, and hospitals. A health care system that works as a unit rather than as a bunch of disjointed parts. This reminded me of the article that Atul Gawande last year, which included praise for the health care system in Grand Junction, Colorado. What made Grand Junction stand out was the cooperation between hospitals, doctors, and the local HMO, all working to improve patient care and share information rather than competing with each other.
The Dartmouth Atlas report is an excellent reminder that simple answers are not always the best ones. Simply expanding access to primary care won’t fix our health care system. We need to make sure everyone has health insurance (first step in expanding access). We need to make sure there are enough primary care physicians (and other care providers) to go around. And then we need a systematic, coordinated effort between health care providers, hospitals, and health insurance carriers to make sure that everyone is on the same page. Expanding access to primary care is part of the solution, but it will only work in tandem with the other parts.