Basic Health Access

Numerous documents indicate the reasons for increasing US health care costs. Most are written by the designers of health care. This puts them in the unique position of not understanding health care cost, quality, and access from the perspective of most of the American people as they care so little for them - by design.  The Seven Drivers are listed from Kaiser Health News (KHN) which use the Bipartisan Committee as a source. The numbered statements are from them. The rest is from RCB. 1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient The KHN says fee for service is bad. It certainly is the way that non-primary care manages to find ways to generate more revenue and bypass any cost saving reforms. Fee for service has been the way to build services and workforce – with the consequence of high costs. Fee for service is a way to reward volume and development of services and workforce, ...

The United States has a health policy construct that actually prevents recovery of primary care. Primary care revenue support is insufficient to keep up with the increasing cost of delivering primary care. New types of costs burden primary care practices further. Meanwhile the rewards for non-primary care choices have increased. The rewards are greater for primary care graduates that depart primary care. The rewards are greater for employers who receive more revenue when graduates convert from primary care. Prevention of Primary Care Recovery By Design Accelerating cycles of primary care deficits are the result of US policy. The cycle starts with primary care deficits. Innovative academicians create new sources of primary care. The designs are generic to workforce needs and are not specific to primary care or most needed primary care. Despite more sources and increased graduates in each source, there is less primary care result per primary care graduate. Studies co...

Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as "shared savings." Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is that Medicare designers need to understand the basic health needs of most Medicare patients left behind by design. Medicare and Medicaid face significant challenges. Spending will continue to rise with more patients covered such as the doubling of the elderly from 2010 to 2030. The United States has continued to add more drugs, treatments, drug coverage, reasons for hospitalization, and technologies that are most costly. Politicians shout Death Squad rhetoric for any attempt to limit services. Meanwhile those needing basic services such as primary care ...

Solutions for health access primary care workforce Enter primary care practices at highest proportions after training Stay in primary care practice at highest proportions in the years after graduation Have the longest health professional career lengths Remain active in practice during a career at the highest percentages Deliver the highest volume of primary care when active in primary care delivery. Are most likely to be found in 30,000 zip codes with 200 million Americans and only 25% of total workforce (Practice Locations Outside of Concentrations) and Are least likely to be found in 1000 zip codes with only 11% of the population and 50% of the workforce (Super Center Concentrations). Only family medicine residency graduates meet all of these criteria for graduates past, present, and future. Only family medicine residents have not been increased beyond the 3000 annual graduates first reached in 1980. The US primary care design has also not changed for pr...

Comprehensive Rural Programs Are Not Enough to Overcome US Maldistribution By Design There is no evidence that Rural Programs in Medical Schools actually increase rural workforce when considering the outcomes of the parent schools. Even with expansions of annual graduates in the parent schools, there has been no improvement. There is nothing wrong with rural programming. It is possible that health access outcomes could decline without rural programming or it might be possible to demonstrate problems resulting from inadequate preparation for the demands of rural practice. The fact is that rural programming has not been able to overcome overall changes in the US health design. Rural programming has not been able to keep up with population changes that increase demand such as increases in elderly, poor, and lower income patients. Lack of health spending for rural populations is the likely reason why rural programming or generic expansions are unable to improve rural access to care....