Basic Health Access

The latest headlines spout 250 million saved for Oregon in the movement to Primary Care Medical Home. Claims of savings often fail to consider the additional costs of an intervention or the supplemental government or foundation funding required. Based on $105,000 additional cost per primary care physician per year the following table demonstrates $250 million to 1 billion dollars more in cost for primary care medical home across Oregon. It is important to consider not just the savings, but also the higher costs of new models. Specifics are not given but the impact of the primary care medical home can be estimated across the number of clinics that could participate and the doctors per clinic over a 2 or 3 year period. The number of doctors may be small compared to actual. The high and low levels are shown along with a possible average cost. If studies involved less than 2 years they should not have gained print. The limitations in new studies with new measurements as measured an...

Wisconsin family physicians intended a summit meeting focused upon workforce. Numerous connections were made. There have been improvements in primary care training support, but is Wisconsin closer to a specific solution for inadequate health access? Sticking with a specific intent is very important, as are state and local organized  efforts to resolve health access.  The continued summit efforts in Wisconsin have resulted in grants for family medicine residencies and generic funding for primary care training. Whether these are targeted specifically for Wisconsin (with obligations), for permanent primary care where needed (family medicine or legislated family practice arising from NP and PA), or for optimal health access focus of training remains to be seen.  In a nation where generic primary care training only result in 20 – 30% primary care, most of the so-called primary care funding goes to create non-primary care clinicians. States have funded more fami...

(And other 3 letter acronyms representing failure for the past three decades) A nation divided continues to either promote ACA or protest it. Regardless of pro or con, many barriers to care remain as with health care designs 1983 to 2014 and beyond. This post was stimulated by a recent family medicine piece reviewed situations facing practices in Sugar Land and Arlington in Texas. It is true that all practices face the challenge of patients who do not understand how insurance works. But there are substantial health access barriers that remain and ACA may actually complicate health access for those in need of care. Focus must be returned to the substantial health access failures with minimal distractions. It is frustrating to see illustrations of practices in wealthier areas such as Sugar Land Texas. At these locations FM competes with a wide range of other providers for patients with insurance coverage better than ACA, Medicaid, and Medicare. It is not a surprise to see fam...

Another publication, this time from Pediatrics, indicates the value of a medical home . But is this value about the term “medical home” or is this value about the concepts that are associated with “medical home”- concepts that any number of providers and clinics can address. In addition, this is a poorly conceived study with a major failure to consider the real reasons for differences - social determinants that shape access, continuity, and better outcomes. What Do Medical Home Studies Indicate? Associations and researchers are willing to use data sources that are not from “official medical homes” to indicate medical home value. Concepts are considered more important than the primary care people who deliver the care. Of course those who cut primary care funding fail to understand they are cutting the experienced people needed to deliver primary care. Primary care is about people – repeat often, especially when examining studies about primary care.  Methods that select p...