Primary Care America's Health in a New Era (1996) / Chapter Skim
Currently Skimming:
Introduction
Introduction
Pages 13-26
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 13... ...
Efforts to encourage primary care in the past have included federal and state support for training of primary care clinicians, direct support for the organization of primary care services to disadvantaged populations, and development of health maintenance organizations (HMOs) and other financing mechanisms that encourage primary care.
|
From page 14... ...
Today, powerful economic forces in the health care market, especially the actions of large purchasers of group health benefits, are driving a shift away from specialized services and toward primary care. In the absence of comprehensive health care reform, these market forces are likely to remain dominant in reshaping health care.
|
From page 15... ...
· ways to make primary care available to all Americans, regardless of economic status, geographic location, language, or cultural background; · financing mechanisms that encourage quality primary care rather than episodic interventions late in the disease process; · a primary care workforce sufficient in numbers to meet the needs for primary care, equipped with appropriate skills and competencies, and prepared to work in teams that include primary care physicians, nurse practitioners, physician assistants, community health workers, and other health professionals; · an enhanced knowledge base for primary care, drawn from clinical and health services research; and · program evaluation, dissemination of innovations, and continued education of both clinician and patient as means continually to improve the primary care system in an era of rapid change. As can be seen from these objectives, primary care is not just a label for a set of clinicians.
|
From page 16... ...
Attention will be given to the issues of the overall financing and organization of services as well as to the training and deployment of the primary care work force. An interim report providing the initial conclusions of the committee concerning the definition of the primary care function will be issued in September, 1994.
|
From page 17... ...
Public Hearing In December 1994 the full committee held a public hearing to gather information about a broad set of issues, including (a) the scope of primary care; (b)
|
From page 18... ...
featured a structured discussion by a diverse group of health professionals about the roles of the various health professions in carrying out the function of primary care. Materials and views from this workshop are reflected throughout this report (and especially in Chapters 3 through 7~.
|
From page 19... ...
The important 1961 article "The Ecology of Medical Care," written at a time when the growth of specialized care was well under way, used epidemiological analysis to show that most health care problems were appropriately addressed in the primary care setting (White et al., 1961~. Concerned by the decline of general practitioners as key providers of primary care, several major commissions issued reports in the 1960S1 that encouraged the establishment of family practice as a new primary care specialty.
|
From page 20... ...
More well-known efforts to expand access to care were the Medicare and Medicaid programs for, respectively, the elderly and selected parts of the poor population. The 1970s By 1976, a growing belief that primary care physicians were in short supply led to federal support for the training of general internists and general pediatricians in addition to family practitioners.
|
From page 21... ...
Other Forces Despite the failure of comprehensive reform efforts, rapid changes in the organization and financing of health care continue, driven primarily by powerful forces in the health care marketplace. These forces are likely to continue and constitute the context in which the future of primary care will be determined.
|
From page 22... ...
To compete effectively for patients and to meet the concerns of health plans, employers, and governments to hold down costs, physicians and institutional providers are increasingly forming integrated delivery systems built on a foundation of primary care. As the committee observed in its site visits to areas where markets have advanced far into this competitive managed care environment, physicians and hospitals are finding it difficult to survive without joining some form of organized arrangement for health care.
|
From page 23... ...
Laws have also been passed or are being considered that designate certain specialties as part of primary care. State legislative actions have also expanded the scope of practice of nurse practitioners and physician assistants in many states, which has implications for the role of these clinicians in the provision of primary care.
|
From page 24... ...
Their complex governance patterns make rapid change difficult under any circumstances, but their increasing dependence on clinical income, most of which is derived from highly specialized services, to subsidize their educational and research missions puts these institutions at a competitive disadvantage relative to health care plans that do not have these missions. Furthermore, an emphasis on primary care is at variance with the traditional clinical base of specialized, tertiary care services found in many institutions.
|
From page 25... ...
Chapter 6 describes the pnmary care workforce and calls attention to the need to address all components of that workforce in concert, and Chapter 7 focuses on education and training issues for pnmary care clinicians. Chapter 8 identifies high priority research topics and documents the need for developing the infrastructure to support research efforts in this field.
|
From page 26... ...
Willard Committee. Meeting the Challenge of Family Practice: The Report of the Ad Hoc Committee on Education for Family Practice of the Council on Medical Education.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.