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Primary care in transition
1Department of Medicine, University of California Medical Center, San Francisco.
JAMA
|November 16, 1994
Summary
The supply of primary care physicians is declining due to managed care and reimbursement issues. Proposed solutions include separate fee schedules and budgets to support primary care practice.
Area of Science:
- Health Policy
- Medical Economics
- Primary Care Medicine
Background:
- A shortage of physicians in primary care is a recognized issue.
- Managed care and resource-based relative value scale (RBVS) implementation negatively impact primary care physicians.
- Primary care physicians face challenges due to lower affluence, influence, and numbers compared to specialists.
Purpose of the Study:
- To analyze the impact of current healthcare trends on primary care physicians.
- To propose strategies for protecting and enhancing primary care practice and physician supply.
Main Methods:
- Qualitative analysis of healthcare policy and economic factors affecting primary care.
- Review of existing reimbursement models and managed care structures.
- Identification of barriers to primary care physician recruitment and retention.
Main Results:
- Managed care and RBVS implementation have had unintended negative consequences on primary care physicians.
- Primary care physicians are disadvantaged in negotiations with payers and among peers.
- Existing support for primary care may be insufficient or superficial.
Conclusions:
- Separate primary care fee schedules and budgets within health plans are proposed.
- Modifications to consumer protection rules impacting primary care are suggested.
- Development of statewide primary care associations is recommended to increase bargaining power and mutual support.