Other nations have primary care delivery practices that could be model for U.S. health care

Illustration by Maria Corte
_{© The Commonwealth Fund}

Payment problems and a workforce shortage are creating a perfect storm of difficulties for primary care within the U.S. health care system.

Meanwhile, other developed nations have methods of primary care delivery that could serve as examples for the United States.

The discussion came as part of a Commonwealth Fund online meeting about its new “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System.” The analysis compares the United States with nine other wealthy nations across 70 performance measures of access to care, care process, administrative efficiency, equity and health outcomes. The evaluation isn’t good, with the United States dead last or second last in four of the five areas, although America shines in care process.

Medical Economics inquired about examples of primary care policies, investments or other practices that are working in other countries, that could be implemented quickly, at wide scale in the United States. Here are expert opinions from Reginald D. Williams II, Commonwealth Fund vice president for international health policy and practice innovations; President Joseph Betancourt, MD; and immediate past President David Blumenthal, MD.

This transcript has been edited for length and clarity.

Medical Economics: Do you have any examples of primary care policies, investments or other practices that are working in other countries, that could be implemented quickly, at wide scale in the United States?

Reginald D. Williams II
_{© The Commonwealth Fund}

Reginald D. Williams II: When we look internationally, there are a number of different examples of how countries have tried to structure their system. As David mentioned, despite some of the current challenges, the UK's system has been rather effective in trying to provide primary care at the local level. We often point to the system in the Netherlands, where community-based care providers are supported in meeting the needs of patients in their local communities. And so if you were to extrapolate that into the U.S., you can see how we could build upon some of the systems we have at the local level to provide broader, more effective care services. I think what we also see in countries like Australia is a clear payment system and structure that supports having local primary care providers be available to people on a regular basis. There are ways that we could create incentives within our Medicare and Medicaid programs and look to private sector advances like community-based health clinics, and use those as a basis for building a system going forward. Joe, I don't know if you want to speak a little bit about your experience and working at the community level in primary care.

Joseph Betancourt, MD
_{© The Commonwealth Fund}

Joseph Betancourt, MD: I think the two areas we're working on at the Commonwealth Fund around this is payment reform. And so certainly, our work around value-based payment is something that I think is moving forward quite nicely. And that work, I think, is innovative, and certainly a model that if put in place, could advance primary care significantly.

I think the other area that's important to put in context here, as it relates to any conversation around primary care, is the primary care workforce shortage and how that crisis is, in fact, worsening. So, we have a decline in primary care providers without supplements coming behind by way of training and significant payment gaps between specialists and primary care doctors that have all created a bit of a perfect storm. Average age of a primary care doctor, 60 years old – a bit of a perfect storm now. So above and beyond just payment, above and beyond just international models, I think some of the key things that we need to address from a primary care standpoint nationally are the workforce crisis, administrative burden and payment reform.

David Blumenthal, MD
_{© The Commonwealth Fund}

David Blumenthal, MD: If I could just add one more point around the Netherlands, and also some other countries. Primary care physicians in Netherlands are required to have coverage after hours. So, you will as a person in Netherlands, you always can get access to your primary care physician or a covering physician, 24/7. That, of course, is not true in the United States, and that shows up in the fact that Americans are most likely to report difficulties getting after-hours care, resulting in their use emergency rooms for after-hours care. That's a very simple intervention. It would reduce the cost of care, reduce the access problems, and reduce the administrative complexity of care.