Comments on: Primary Care: Divergent Paths In U.S. And Abroad http://healthaffairs.org/blog/2008/11/14/primary-care-divergent-paths-in-us-and-abroad/ The Policy Journal of the Health Sphere Tue, 24 Nov 2009 19:57:48 -0500 hourly 1 By: acavale http://healthaffairs.org/blog/2008/11/14/primary-care-divergent-paths-in-us-and-abroad/comment-page-1/#comment-23738 acavale Sat, 15 Nov 2008 19:51:26 +0000 http://healthaffairs.org/blog/2008/11/14/primary-care-divergent-paths-in-us-and-abroad/#comment-23738 Intersting observations. One line strikes me as interesting ... "U.S. patients were significantly less likely than others to have a personal physician or long-term relationship with a doctor". In my opnion, a solution to this problem could address multiple issues associated with the US healthcare system at this time - access to care, cost of care, coordination of care, and improvement in the medicolegal situation. There are at least three probable causes for this phenomenon (effective dismantling of the patient-physician relationship): 1) Unscruplous trial lawyers who continue to drive a wedge in this most sacred relationship 2) Business-minded insurers who create "in-network" and "out-of-network" groups of physicians, resulting in elimination of many community physicians by default. This results in patients being shifted from one practice to another based only on who is "in-network". 3) Untimely disappearance of many (mostly Primary care) physicians due to unbearable regulations/cost of doing business/lack of successful business model for small practices/small practice takeovers by local hospitals, etc. Unfortunately, almost all current efforts (both governmental and private) have gone towards helping promote large goup model practices, which may work well for process-efficiency but does harm to promoting a long-term patient-physician relationship. A better way would be to simplify the proceses and create a viable business model for small practices to flourish in communities, thereby ensuring their longevity and subsequently helping develop lasting, trusting patient-physician relationships. Intersting observations. One line strikes me as interesting … “U.S. patients were significantly less likely than others to have a personal physician or long-term relationship with a doctor”. In my opnion, a solution to this problem could address multiple issues associated with the US healthcare system at this time – access to care, cost of care, coordination of care, and improvement in the medicolegal situation.

There are at least three probable causes for this phenomenon (effective dismantling of the patient-physician relationship):
1) Unscruplous trial lawyers who continue to drive a wedge in this most sacred relationship
2) Business-minded insurers who create “in-network” and “out-of-network” groups of physicians, resulting in elimination of many community physicians by default. This results in patients being shifted from one practice to another based only on who is “in-network”.
3) Untimely disappearance of many (mostly Primary care) physicians due to unbearable regulations/cost of doing business/lack of successful business model for small practices/small practice takeovers by local hospitals, etc.

Unfortunately, almost all current efforts (both governmental and private) have gone towards helping promote large goup model practices, which may work well for process-efficiency but does harm to promoting a long-term patient-physician relationship. A better way would be to simplify the proceses and create a viable business model for small practices to flourish in communities, thereby ensuring their longevity and subsequently helping develop lasting, trusting patient-physician relationships.

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