The biggest health care fix: a relentless focus on primary care

There are so many theories out there about what we should or shouldn’t be doing with our complex and fragmented health care system. We are facing a perfect storm of factors: an aging population, a huge increase in chronic disease, new and expensive treatments, and rising expectations of what care we should be receiving. All of this is sending costs spiraling out of control. As a nation, we spend almost 3.5 trillion dollars on health care. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of 3.4 trillion dollars. If the brakes are not somehow applied, spending could reach over a third of entire GDP within 30 years — a figure that would quite simply destroy the American economy. Currently, at 18 percent of the economy, we spend almost double the OECD GDP average percentage of other western nations. Yet our outcomes are nowhere near what they should be.

In 13 years of working in this health care system, my most striking fundamental observation of what needs to be done first and foremost, may sound rather simplistic, but if we are serious about improving things: Strengthen primary care and make it the backbone of American health care. In a nutshell, as someone who has experienced health care on four different continents — compared to other Western countries, our primary care system is pretty terrible. There’s a vast body of research that shows how nations with strong primary care have significantly better population health. Essentially, it all boils down to 3 elements: 1) everybody has easy access to a primary care physician; 2) better follow-up for chronic disease; and, 3) reducing utilization of more expensive services such as hospitals.

Here are three things the U.S. needs:

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