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May 9, 1990

The Runaway American Health Care System

JAMA. 1990;263(18):2446-2447. doi:10.1001/jama.1990.03440180044015

To the Editor.—  There is no doubt that the American medical care system has major problems. Many of these are well documented in the recent communication by Drs Davies and Felder.1 I believe that one of the factors that is closely related to the problems they reviewed was not mentioned in the article. This factor is the lack of primary care physicians in the United States. The United States not only spends more money per capita for medical care than any other westernized country, we also have a smaller percent of our physicians in primary care.2 Health maintenance organizations, which have lower costs per enrollee than indemnity plans, average 51.4% primary care physicians (family practice, pediatrics, and general internal medicine).3 This percentage is far greater than the estimated 27% of American physicians who currently function as generalists.4 Primary care physicians who provide coordinated, comprehensive, and continuous