Distribution Failures Behind By Many Designs

The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand.

As previously noted, the locations with top concentrations of physicians have lowest proportions of family physicians and primary care. 

Numerous forces interact to shape higher proportions of family physicians where care is most needed and where higher proportions of elderly are found. These are counties most behind in education, employment, and poverty in addition to health spending, health facilities, and health care workforce.




Slowest population growth is seen in counties most concentrated in health workforce. Highest cost of living and health care may shape most Americans elsewhere, especially the elderly and those on fixed or lower incomes. 

Designs for health, education, and economics fail where needed. Population based distributions are more important where care is needed but are falling behind due to sequestration, cuts in Social Security, cuts in SNAP (nutrition), cuts in child development, cuts in early education, cuts in primary care and basic services, readmission penalties, pay for performance, and other impairments specific to small facilities, small practices, and care where needed. 

As more funds are diverted outside of the county for consultants or software or technology in education and health care, less remains to deliver care. 

High costs of recruiting teachers, clinicians, and others plus high costs of retaining them make it even more difficult.

Simplistic changes in small areas will not resolve health access and other problems.

Designs must be specific to the counties and populations in need.


William T Butler, MD, in his Academic Medicine's Season of Accountability and Social Responsibility

Recent Blogs


Still Failure After All These Years

Acting Upon Discrimination in Health Spending

Understanding Common Errors in Quality Studies

Real Reasons for Rotten Outcomes

Too Many and Still the Wrong Clinicians

The Government Control Card Still Plays Well

Rotten Apples, Rotten Support, or Rotten Media?

Improving Health Care is Not Likely for 2600 Counties

Global Fails Local But Local Focus Succeeds Globally

Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...

Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand


Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressive and in
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about Tru
Read more

Innovation Is the Problem Not the Solution for Worsening Health

Image
Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions. It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future. If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitatio
Read more