Primary care is key to health care overhaul
As we are at the start of a new presidency facing the economic and public health devastation of the pandemic, it’s the right time to consider how to improve access to quality health care — that is primary care. As a pediatric doctor supporting my patients through the trauma of the pandemic, I am acutely aware of how critical it is for patients to have a doctor dedicated to their health and wellbeing.
Access to primary care was a problem before the pandemic. Americans were already seeing their primary care docs (if they had one at all) less than before — and it’s not hard to see why. Paying $50 to $200 for a visit with a doctor when one feels perfectly fine can seem absurd. Furthermore, even if a patient seeks time with their doctor, appointments can be difficult to get. Despite being an insider to the medical community, I had to wait three months to get a “well check-up” at a time when I wasn’t working. I cannot imagine how difficult it is for patients who have other demands on their time like working multiple jobs or caring for dependents to fit in time to see the doctor.
Primary care doctors are also meant to be the first line when a patient is sick. Unfortunately, urgent care centers and the emergency department have become the first line of care for many. I saw countless patients in the emergency department this winter who could have been adequately treated by an outpatient doctor. An emergency room or urgent care visit can cost around $100 to $2,000plus depending on your insurance (more expensive than a visit to the primary care office), but many patients aren’t totally aware of the cost. Others feel forced to choose the emergency department because of the immediacy of the attention from a health care provider. My mother recently developed a concerning swelling in her face and found she would had to wait four weeks to see her own doctor. I guiltily recommended she go to urgent care even though her doctor could follow up rather than rule out emergencies and send her home.
The benefits of increasing access to primary care are obvious to most doctors. Access to primary care means better management of chronic conditions, and therefore fewer heart attacks or diabetic amputations. Unnecessary emergency room visits could be prevented by a patient first seeing their primary doctor, thus reducing diversion of health care resources to non-urgent patients.
Furthermore, a primary care doctor can be an ally in the fight against racial disparities in health care and a support in the face social determinants of health. Primary care interventions have been shown to reduce child abuse and the effect of poverty on development and health. A strong patientdoctor relationship can combat misinformation, which would be particularly helpful in the current confusion over vaccines and viral spread. These urgent needs have been made even more obvious by the global pandemic and energizing of the antiracism movement.
There are those who will say this is not a priority. To those I would ask — what do you imagine the “new normal” will look like? We have a brewing mental health crisis, chronic conditions that have not been adequately treated for the past year and unknown chronic complications for the millions who have been infected. The pandemic has made access to care an emergency — particularly as many primary care providers have been laid off during the shutdown. Many would shy away from the potential cost of policy addressing access to primary care, but that is because the cost-saving investment in primary care is undervalued in the U.S. Countries with more limited governmental budgets than ours have had success in creating robust community health centers. Even the poorest, most rural patient in Costa Rica has access to a regular doctor.
What feels like ages ago, there were calls during the Democratic primaries for “Medicare-for-all” or “Medicare-for-all-who-want-it,” and even those who opposed both options recognized the need for change. What excuse do we have for not improving what we know is broken? This is the perfect moment to enact policy that would increase access to primary care. Block grants for primary care offices, decreasing co-pay for primary care and ensuring that primary care is the gatekeeper to specialist care would make a dramatic change in the health of our country without the dramatic overhaul of the health care system. I challenge our policy makers to invest in our future health by investing in primary care.
Access to primary care means better management of chronic conditions, and therefore fewer heart attacks.