Consider the WHO definition of primary health care. Discuss in what ways the United States has succeeded or failed in adhering to the practices described in the definition based on its three basic elements of POINT OF ENTRY, COORDINATION OF CARE, and ESSENTIAL CARE. Include implications on the key system values of quality, cost, and access in addition to any factors you might include. Provide examples whenever appropriate.
(i) Respond with a post having at least 500 words. Indicate the number of words at the end of the post.
(ii) Prepare a response in support or opposition to the post of one member of the class. At least 200 words; indicate the number of words at the end.
(iii) You MUST include at least one text citation in APA style to support your arguments.
The World Health Organization’s definition of primary care: “Essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and family in the community by means acceptable to them and at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self-determination. It forms an integral part of both the country’s health system of which it is the central function and the main focus of the overall social and economic development of the community. It is the first level of contact of individuals, the family, and the community with the national health system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing healthcare process.”( Shi & Singh, 2019).
The United States fails in some areas of the WHO’s definition of primary care and succeeds in others. Point of entry, or gatekeeping. Gatekeeping is the job of the primary care provider to evaluate an individual to the highest ability within their scope of practice and only refer them to the hospital or a specialist if needed. Going this route is thought to protect the person from unnecessary medical procedures and the financials that follow. This idea works without question in areas where specialty care is lower, such as in the UK, so there is a great support for the gatekeeping mentality. In the U.S. however where individuals believe that specialty care is limitless, there is a higher degree of dissatisfaction. The definition is a success when patients seek care from their PCP first, and accept referrals as necessary to specialists but fail when some specialists and insurances do not require a referral to their office, as well as provisions put into place by the government to allow patients greater access to specialist. Currently, only 38% of the U.S. population has a primary care doctor who acts as the gatekeeper of their care. In the U.S., patients are twice as likely to see a specialist than in other countries such as the U.K. As more people obtain PCP care, the point of service options grow as well and attach to the cost/quality/access elements of healthcare. An example of this Is a point of service plan that gives a patient options to use a referral from the gatekeeper or for a higher price refer themselves to a specialist. This option gives the illusion of a less restricted say in one’s health decisions all the while most are still referred by the PCP, access to this this self-referral option is provided only by one’s ability to pay for it. (Forrest, 2003)
Coordination of care is another job of the primary care provider in which they arrange the different types of care the individuals needs, the PCP is the consolidation point between the various types of care a patient will need over time such as the specialists, the hospital care, surgery, and diagnostic services. Care coordination also is very dilated in organizing patient care to achieve a more effective healthcare experience for the patient. There are two ways of achieving a better care coordination in which the U.S. thrives and some in which it falls apart. The first is a broad care coordination approach. This includes “teamwork, care management, medication management, health information technology, and patient-centered medical home.” (AHRQ, 2014). The U.S have a vast spectrum of providers coming together to jump to the opportunity to care for its patients, but is that care managed properly, is the medication reviewed as it should be, does everyone have the same access to the patients health information through HIT. This is where the U.S. falls behind though there have been strides over the years to enhance these goals. Secondly is specific care coordination activities including, “establishing accountability, communicating knowledge, helping with transitions of care, assessing patient needs and goals, creating more proactive plans, linking community resources.” (AHRQ, 2014). The U.S. fails here with the current health system being incredibly disjointed and the processes for patient care vary between sites and providers. Patients in the system tend to also be very uncertain over the reasoning behind referrals and their next step to scheduling that appointment. Then there are gaps after the fact including the PCP being informed of the specialist visit, where the specialist isn’t always informed on why the patient presents either. This leads to further testing, sometimes unnecessarily, driving up the costs for the patients. Access to specialists and others where it is not handled neatly bogs down the system and prevents care and accessibility for others and lowers the quality of care for the patient with the many different processes involved from not only the providers but the referral staff as well.
Essential care where the health delivery is set to optimize the health of the population and not just of individuals who have better means to access it and addressing healthcare disparities. Essential care is to provide the essentials in healthcare, and this occurs but leave out many of the more vulnerable populations such as minority and indigent populations. The U.S falls way behind in this area in terms of cost, quality, and access as there is a disproportionate risk of being uninsured in the racial/ethnic minorities groups. This also means this group suffers from worse health outcomes from illnesses that are preventable, or treatable. There is also evidence that along with the cost, and access, the quality of healthcare also lags where the life expectancy is shorter and infant mortality is higher. (Jackson & Garcia, 2014)
On a more opinionated bases- The Unites States hits a few nails on the head with providing healthcare such as its vast and ever-growing technological advances, but falls way behind on the human aspect, the aspect that truly drives the system. The system itself does not always cater to the patients and what is best for them, the system is driven create repeat customers. To clog this turn of pumping out customers and driving costs higher and high, and to best address all these issues, a universal, or national healthcare system program is the next logical step.