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Research Letter
Health Care Reform
December 16, 2019

Characteristics of Americans With Primary Care and Changes Over Time, 2002-2015

Author Affiliations
  • 1Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Harvard University, Boston, Massachusetts
  • 3Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 4Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
  • 5Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Intern Med. 2020;180(3):463-466. doi:10.1001/jamainternmed.2019.6282

Receipt of primary care is associated with better health.1,2 Despite the benefits of primary care, Americans’ receipt of primary care, changes in receipt of primary care over time, and differences in receipt of primary care according to sociodemographic and clinical characteristics are not well known.

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    1 Comment for this article
    It's our culture and the system, stupid!
    Jeoffry Gordon, MD, MPH | solo family doctor
    For at least 30 years the ratio of specialists to primary providers (docs, PAs, and RNPs) in the US has been around 2:1 (with the marked exception of the Kaiser system). In most other advanced, industrialized nations the ratio is the reverse with 2 primary care providers for every specialist. Many studies show this not only produces more satisfaction and continuity of care, with higher quality on many parameters, but also less 'excessive' care, all with less cost on the aggregate.
    Lower use of primary care is built into the system, by the types of docs we educate, to the
    debt burden of education (almost 50% of graduates have $200,000 in loans or more), to the reembursement system which has always paid procedures in medical care (specialists) disproportionately more than cognitive care, to the emphasis on high tech medicine which often produces only marginal benefit at high cost. All of this validly reflects the culture of America and the public policies it generates and supports.