Coordinated Care Needed Now
Boost the number of primary care physicians: It's a refrain we hear repeatedly in the healthcare reform debate.
A new study from the Dartmouth Atlas Project adds another layer to the debate. But here's the rub: the study authors don't expressly call for more primary care physicians. Numbers alone won't do the trick, they say. The study says neither higher amounts of primary care services nor routine visits with a primary care clinician is by itself a guarantee that a patient will get recommended care or experience better health outcomes. What works? Coordination of care, the authors say.
"As is often the case in health care—it's not always how much you spend, but how you spend it," says one of the study's co-authors, Elliot S. Fisher, MD, MPH, co-principal investigator for the Dartmouth Atlas Project. The Dartmouth Atlas Project is run by the Dartmouth Institute for Health Policy and Clinical Practice.
The study, Regional and Racial Variation in Primary Care and Quality of Care Among Medicare Beneficiaries, examined the relationship between the per capita supply of primary care physicians and the percent of Medicare beneficiaries who had at least one annual visit with a primary care physician during 2003-2007. It "suggests that there is no correlation between the supply of physicians and access to primary care," according to Fisher.
"Achieving the benefits of primary care is likely to require both improving the services provided by primary care physicians and more effective integration and coordination with other providers," the study says. "A higher supply supply of primary care may be important in smaller areas, but unfortunately, public policy and reimbursement practices have not matched patient needs with supply at any level, local or regional."
In a study of fee-for-service Medicare population from 2003-2007, the study points out that improving access to primary care doesn't always keep people with chronic conditions out of the hospital, or improve their chances of getting optimal care. Those conditions include diabetes, and congestive heart failure, as well as screenings for breast cancer or eye examinations, and leg amputations.
Access to primary care physicians also may not be enough to overcome racial disparities in quality and outcomes, the study says. Too often, people most in need of primary care simply don't receive the necessary care as well, according to the authors.