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Over View for the Health System

Over View for the Health System

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Published by Wissam Alnaemah

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Published by: Wissam Alnaemah on Apr 29, 2012
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Over view for the health system and

the primary care practice in the United States

Ahmed M. Rashad

Basic Facts About U.S. Health Care System
• Most expensive in the world • Technology is key driver • Insurance coverage is often linked to employment • For most, insurance coverage is voluntary • More than 45 million Americans are uninsured • Spend more per capita (almost $6,000) and a higher % of GDP (about 15%) on health care than every other industrialized country

Health Care System is very complex Government Out of Pocket Payments Providers Premiums Employer Insurance .S.U.

S.3% 64.30% 13.0% Employer Medicaid Private Insurance Uninsured Medicare .U.1% 14.3% 10. Health Insurance Coverage 2000 8.

0% Federal Other .Where Does US Spending Come From (2003) 11.0% 16. Out-of-Pocket State 4. Ins.0% Pvt.0% 33.0% 36.

Per Capita Growth In Health Care Expenditures 1970-2001 (Trendline calculated for period 1970 – 1997) 1600 1400 1200 1000 800 600 400 200 0 19 70 19 72 19 74 19 76 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 .

It has been addresses by the WHO since the 1940s as a policy to achieve universal affordable medical coverage. . developing sustained partnership with patients. accessible health care services by clinicians that are accountable for addressing large majority of personal healthcare needs.Primary Care Physicians Definition “the provision of integrated. and practicing in the context of family and community”.

Who is practicing primary healthcare in the US 50% 40% 30% 20% 10% 0% Family Internal Pediatrics Ob & Gyn Doctor Medicine Series1 .


. • about 20% lacking the usual healthcare services due to the double digit rise in the health insurance premiums. • Healthcare system is highly fragmented. • Poor quality • Raising complain about the disparities in healthcare services is a dangerous issues.High demand for the Primary Care Practice in the US • About 15%. of the American population are uninsured. • Weak infrastructure and adequacy of health force is uncertain.

• Strong primary care infrastructure can provide equitable cost-effective health care as it can reach to the low income groups of the community and support them with the basic medical care.Qualitative Demand • Primary Care Practice can provide. • Primary care base healthcare delivery system has the ability to improve quality while reducing cost. . a comprehensive solution for most of these problems. if well designed.

radiology.4 hours per day to provide preventive care to an average panel of 2500 patient which is less than the mean US panel size by about 800 patients • About 80 million patients are in need for the PCP to get his/her permission for the laboratory.Quantitative Demand • The Primary Care Physician (PCP) in the United States needs 10. • Thirty three percent of patients failed to have an appointment with their PCP in 2003 raised from 23% in 1997. and specialist services.6 hours per day to deliver the recommended care for chronic patients. . plus 7.

The Perceived Market Need Primary care practice in the US is evolving as a result of market pressure and not due to structural governmental activities  The development of Managed Care Organization during the 90s and the need for the primary care doctor gate keeper function.  Decreasing job satisfaction and the increase in the educational debit and salary disparity. create a strong sense that becoming a primary care doctor a strange errand. .

. • Specialties portion increased from 32% to 38%.Not attractive specialty Medical Students do not like to work as a Primary Care Physicians • The percentage of the US medical school graduates entering the primary care field dropped to 38% in 2006 from 50% in 1998. primary care portion declined by 3% from 1995 to 2003. • Number of US medical students entering family practice reduced by 50% between 1997 and 2005 and 80% of physicians enters it in 1998 became sub specialists or hospitalists. • The percentage of the 3rd year residents in internal medicine planning to become primary physicians dropped from 54% to 27% for the same period.

S. Data are from the National Resident Matching Program . .Not attractive specialty Percent Change between 1998 and 2006 in the Percentage of U. Medical School Graduates Filling Residency Positions in Various Specialties .

• Medicare increased rates for doctors by 13% from 1995 to 2003 while the inflation rate was 21% for the same period. . • Private payment and Medicaid even has lagged more than this.2% .Underlying causes of the problem No serious proposals to narrow the gap between primary care physicians and specialties are on the national agenda • Primary care physician is the lowest earning in the United States among other medical specialties. • Physician’s salaries has been declined by average 7% after adjusting to inflation and primary care doctors’ income reduced by 10.

Underpaid Specialty Data are from the Medical Group Management Association Physician Compensation and Production Survey. 1998 and 2005 .

Underpaid Specialty .

• Medical students spent most of their life times as excellent highly ranked students and it is not easy to assume that their personal trait accept to continue the rest of their lives working in a low ranked profession. .Underlying causes of the problem Number of satisfied PC doctors reduced by 12% from 1991 to 1996 • High workload • Unsatisfying academic image is important contributing factors. • Primary Care Practice is not viewed as high niche specialty and not appreciated in medical academic field compared to other specialties.

.How the US address the problem: should include actions on both the primary care practice side (microsystem improvement) and the healthcare system side (macro system-reform).

The Futures of Family Medicine (FFM) project FFM project proposed new model for family practice (FP) characterized by • • • • • • Patient-centered team approach Elimination of barriers to access Including an electronic health record More functional offices Focus on quality and outcomes Enhancing practice finance. .

The Futures of Family Medicine (FFM) project 5 challenges for the future of this practice: • Promoting a broad more accurate understanding of the specialty among the public • Identifying areas for commonality in a specialty whose strength is the wide scope and locally adapted practice type • Winning the academic respect for this specialty • Making the FP a more attractive career option • Addressing the public’s perception that the FP is not solidly grounded in science and technology .

• It also provides a kind of national project for policy reform. . • It does not give direct solution for the low income problems.The Futures of Family Medicine (FFM) project Comments • It is the comprehensive management of the problem • the high complexity in both design and implementation may make them more theoretical than practical solutions.

the chronic care model. collaborative care. • Quality of care and creating what is called “best of times” are core values for these innovations. which are aiming at reduce the workload and increase satisfaction of the primary care doctors. .Innovations in organizing the primary care provision • like Primary care teams. Group medical visits are proactive moves from the PCP representative bodies. advanced access.

.Developing Hospitalists subspecialty one of the approaches has been taken to improve the satisfaction and decrease work load over the primary care doctors through carrying out the function of taking care of the admitted primary care patients.

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