Strong Primary Health Care in the United States – Closer Than We Might Think

Reorienting the American health care system toward primary health care is a promising and evidence-based strategy to improve outcomes with equity while making health spending more efficient. The United States invests more resources in health care than any other country in the world, but in turn produces uneven and inequitable results that are arguably worsening in the past few years.¹ In large part, the US health care delivery system is a “sick care” system focused on acute, technologically oriented hospital and specialty-based procedural care, and much less on community-based comprehensive primary care.

These high investments in acute tertiary care with relatively poor population health returns have created pressure for the health system in the US to evolve necessarily at a rapid rate. This evolution is driven both by the integration of new technologies into care delivery, new market entrants, and persistent policy-driven payment movement away from fee-for service payment and toward population or episode-based payment. Concomitant US efforts in primary care over the last decade have focused on team-based care transformation through integration of health information technologies at the clinic level with nascent but incomplete movement away from solely visit-based remuneration.² ….more