Basic Health Access

AAFP News translates what Family Medicine is doing as a movement, but sometimes more important is what it is not being done. Do the "Families" of Family Medicine focus on what can accomplish the most for family physicians and especially for their patients? The one thing that sets family medicine apart is service to all of the various places and populations that are most left behind by health care design - rural, underserved, elderly, Community Health Center, lowest physician concentration counties, etc.  Broadest generalists are the primary means  to the end of health access where needed. FM as a specialty has a 3 to 5 times multiplier effect for care where needed - the elderly, the poor, rural populations, CHCs, frontier, and lowest physician concentration county. This is because only family medicine distributions at 30 per 100,000 across the wide range of populations while other specialties are more concentrated where physicians, income, health resources are mor...

Policy and Design Seeds of Health Improvement Fail on Barren US Soil - Any number of interventions can work in a nation that invests in children, and improved environments, situations, and social determinants. In nations failing in support, health interventions can be expensive and can fail to work. Medicaid as Savior or Betrayer of Access - Higher payments from Medicaid can increase access for patients with or without insurance. Medicaid expansion with current payments too low cannot support Medicaid patients, local providers where care is needed, or patients with insurance either. Selling and Swelling a Bigger HITECH Bubble - C herry pi cking has become essential for those who provide or insure health care. Choose the easiest route will capture more dollars with less cost of delivery - and this will earn more bonuses and assure no penalties. Changes since 2010 will reward those already doing well and will penalize those already behind. Cherry picking has apparently moved ...

An article by Andrew Weil indicates how "The Biomedical Model is Failing Us." Despite lofty claims, the drugs promoted have not done much for mental health. Not surprisingly the biomedical model may have failed most when applied to mental health where so much is about behaviors, relationships, and other people factors. Weil points out, "In 1977, the journal Science published a provocative article titled “The Need for a New Medical Model: A Challenge for Biomedicine.” I consider it a landmark in medical philosophy and the intellectual foundation of today’s integrative medicine. The author, George L. Engel, M.D., was a professor of psychiatry at the University of Rochester (New York) School of Medicine. Determined to overcome the limiting influence of Cartesian dualism, which assigns mind and body to separate realms, Engel envisioned medical students of the future learning that health and illness result from an interaction of biological, psychological, soci...

Quality measurement focus has resulted in higher cost, distractions from care, and lower productivity. Articles proposing more quality measure emphasis may be popular but will not move homebound seniors toward the care that they need. An understanding of the situations facing homebound seniors is required.   Based on higher levels of disabled payments, Social Security payments, Medicare patients, Medicaid patients, seniors, obesity, smoking, and sedentary lifestyle at least 45% of homebound seniors are found in 2621 lowest physician concentration counties.   It helps to have access to care and workforce to provide care and local resources and many other areas addressed before more quality measures.   Homebound seniors where care is needed face Lack of mobility - condition, housing Lack of transportation - due to family situations and lesser public transportation Lack of insurance competition Insurers who avoid them due to cost and complexity Provider...