Ruth M. Baliweg, PA-C
Sara E. Barger, R.N., D.P.A.
Professor and Chair
Northern Illinois University
Robert C. Bowman, M.D.
Rural Health Education and Research
University of Nebraska Department of Family Practice
C. Patrick Chaulk, M.D., M.P.H. *
Senior Associate for Health
Annie E. Casey Foundation
William E. P. McMiller, M.D., M.P.H.
University of Illinois at Chicago
Jacalyn Ryberg, M.A., R.N., C.P.N.P.
Barbara Sheer, D.N.S.C.
Nurse Practitioner Program
The current medical paradigm has resulted in significant problems and gaps in the provision of health care in the United States. Currently, the U.S. spends nearly $2,400 per person on health care, 40% more than the next highest spending country, Canada. Despite these expenditures, some 37 million Americans are without health insurance coverage, another 40 million are underinsured, and millions more are uninsurable because of pre-existing medical conditions. As a result, in terms of health status – infant mortality, low birth weight babies, mortality rates from cancer, cardiovascular disease and injuries – the U.S. lags behind other countries which spend considerably less.
The root cause of much of this problem can be attributed to the orientation of our health care system, which emphasized diagnostic and procedural-oriented care over primary care. Instead, we need to re-focus our health care system by expanding primary and preventive care for all our citizens. This will result in a reduction in the need for procedurally-oriented treatment, and an improvement in many of our health status measures.
To achieve this goal, the Public Health Service Primary Care Policy Fellows for 1992 strongly urge that the Secretary use all resources at his disposal to facilitate the development of a national model for primary health care. We believe that the central ingredients of this model are the following:
PLAN FOR ACTION
We believe that the development of this system can begin immediately. The Federal role should involve the release of demonstration funds to competitive bidders representing both urban and rural communities, to begin linking existing services, improving quality of care, recruiting providers, and developing the infrastructure which can lead to a sustainable primary care system. As we described in our presentation to you, such a system has been successfully developed in Dallas, Texas. The recent problems in Los Angeles offer the opportunity for targeting Federal support for a variety of community programs which should include opportunities to promote a primary health care model. Experiences gained from such support can be shared with other communities.
Failure to redirect our health care system with a sharp focus on primary and preventive care will only chart us further onto the current troubled course which mismatches high health care spending with poor health outcomes.
Return to the Fellows' Policy Papers