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January 27, 1993

Achieving a Uniform Federal Primary Care PolicyOpportunities Presented by National Health Reform

Author Affiliations

From the Center for Health Policy Research and the Department of Health Services Management and Policy, The George Washington University, Washington, DC.

JAMA. 1993;269(4):498-501. doi:10.1001/jama.1993.03500040064038

FEDERAL policy toward primary care often seems hopelessly inconsistent. Just as there is no uniform, consistent policy toward housing, food, or health care coverage, there is no uniform federal primary care policy. Rather, primary care policy consists of the net total of a wide range of decisions made by several branches of the federal government, most often with no explicit consideration given to primary care. Some federal health legislation apparently establishes primary care as a national priority. Other federal policies leave primary care languishing while specialties and subspecialties prosper.

This article explores the extent of this dichotomy and suggests possible opportunities for modifying the situation. The effects of these de facto federal policies on primary care are identified across four areas: education and training, physician payment, the service delivery system, and research. Based on this analysis, the obstacles to a coherent primary care policy, and possible ways to overcome those