Question

Since primary care is the basis for maintaining health and early diagnosis of potential health problems, who should be responsible for rectifying this misplaced emphasis of health care? Insurers? Medical schools? The government? The AMA? Others?

Answer 1

Primary health care serves as an important element for a strong healthcare system that ensures positive health outcomes and health equity. Primary health care is the basis for maintaining health and early diagnosis of potential health problems. It focuses on the type or level of services, such as prevention, diagnostic and therapeutic services, health education and counselling, and minor surgery.

It forms an integral part of both the country’s health system and the overall social and economic development of the community. It is the first level of contact for individuals, the family, and the community with the health care system. It helps in bringing healthcare as close as possible to where people live and work.

It is sad to see that there is an imbalance in the primary health care. The causes are: advanced medical technology, insurance companies, primary health care physicians and knowledge of the public.

Medical technology: The major cause for this is due to increasing number of medical specialists and the development of medical technology. There is a rapid advance in medical technology and advanced diagnostic and therapeutic options.

Insurance companies: The majority of patients are free from financial constraints because their bills are paid by the insurance and go to physicians who provide up-to-date, sophisticated treatment. These insurance companies reimburse at a higher cost for specialists than for primary care physicians. This contributes to the current imbalance. Many insurance companies pay for hospital-based complex diagnostic and invasive procedures using high technology, but not for routine preventive visits and consultations.

Primary care physicians: Primary care physicians receive lower payments than specialists. Not only do specialists earn significantly higher incomes than primary care physicians, but also they are more likely to have predictable work hours and enjoy higher prestige both among their colleagues and from the public. Problems typically cited in recruiting primary care physicians include longer working hours during the day as well as on call, low paid and less access to the highly technological approaches to diagnosis.

Knowledge: Policymakers and the general public also have little knowledge of the efficacy of primary care, its impact on individual and population health, and its role in today’s healthcare delivery.