How to Build a Health Care System
101
The recent school closings in Warwick, West Warwick,
and Coventry - and the flood of calls and visits to doctors' offices
immediately thereafter -- have shown once again the importance of a
strong primary care base for any health care system. As we try to find
ways of giving all Rhode Islanders access to health care, and to design
a health care system that is both effective and affordable, we would
do well to put the development of Rhode Island's primary care practices
at the center of our efforts.
If one were to examine all health care services, only the number of
primary care physicians per 10,000 people has been shown to predict
the health of the State's population. States that have relatively more
primary care physicians provide better quality care at lower cost. The
expense of health insurance itself is lowest in States in which the
medical community is comprised of a higher percentage of primary care
physicians. As Rhode Island's SHAPE Study showed, we have adequate numbers
of primary care physicians, but those physicians are not organized to
provide same-day services, or evening and weekend office hours. For
most Rhode Islanders, there is rarely a primary care practice that is
conveniently located and open at the most opportune times. If patients
could bring their health problems to a primary care practice, we could
avoid a lot of unnecessary, costly, and even dangerous procedures and
testing that don't improve our health.
Primary care physicians know how to navigate our difficult health care
system. Every Rhode Islander should have his or her very own primary
care physician to help make medical decisions and utilize medical resources
to their fullest and safest potential. That primary care practice can
provide 24/7 advice for health problems, same day office care for sickness,
and oversight of inpatient hospital care. However, just when we need
their services the most, there are a number of financial pressures that
are making it harder for patients to find primary care practices at
all; and those practices no longer have the time or resources to provide
the services that people need to feel well and stay safe.
Our system pays Primary Care Practices (family practitioners, pediatricians,
and general internists) only for seeing patients in quick succession,
by numbers, and not at all for those extra services that people really
need. It would be so much better if a primary care practice was a real
medical home, providing same day access, and having the services of
a nutritionist, lab, x-ray facilities, mental and behavioral health
professionals, and physical therapists on site. Forcing physicians to
see more patients every day to make ends meet limits the time spent
on management of chronic medical conditions, and makes it much more
difficult to provide satisfying and high quality care.
Moreover, young doctors are no longer selecting a career in primary
care, given its high work stress and low reimbursement. With fewer providers
entering the field and most current primary care physicians over 40,
we will soon face a shortage of primary care physicians in Rhode Island.
We call on Governor Carcieri to make good on his October 2005 health
care agenda, which commits the state to "building a stronger primary
care system, through which every Rhode Islander coordinates primary
care and treatment."
Let's not continue to take what is most effective and most affordable
for granted. Let's convene a task force that includes political leaders,
insurers, payers, consumers, and providers, and build a health care
system after all, by building an effective primary health care system
now.
Francis X. Basile, Jr., M.D.
Director, Division of Primary Care
University Medicine Foundation, Inc.
Kerri Jones-Clark
Executive Director
Rhode Island Health Center Association
Michael Fine, M.D.
Hillside Avenue Family & Community Medicine
Pawtucket and Scituate, Rhode Island
Mark Jacobs, M.D.
General Internist
Greenville, Rhode Island
CEO and Founding Partner
Coastal Medical, Inc.
Albert Puerini, M.D.
President and CEO
Rhode Island Primary Care Physicians Corporation
Nathan B. Beraha, M.D.
Medical Director
Anchor Medical Associates
Jeffrey Borkan, M.D., Ph.D.
Department of Family Medicine
The Memorial Hospital of Rhode Island
Pawtucket, Rhode Island
J. Russell Corcoran, M.D.
Chief, Department of Medicine
South County Hospital
Wakefield, Rhode Island
Judith Gibbs-Shaw, M.D.
Providence, Rhode Island
Arnold Goldberg, M.D
Medical Director of the Family Care Center
The Memorial Hospital of Rhode Island
Pawtucket, Rhode Island
Christine Herbert, M.D.
University Internal Medicine
Pawtucket, Rhode Island
Pamela A. Harrop, M.D.
President, Medical Associates of Rhode Island
Bristol, Rhode Island
Ellen Hight, M.D., MPH
University Family Medicine
East Greenwich, Rhode Island
Fellow, Brown University Family Medicine Leadership Program
Hillside Family & Community Medicine
Pawtucket, Rhode Island
Kerri Jones-Clark
Executive Director
Rhode Island Health Center Association
Warren Licht, M.D.
University Medicine Foundation
Providence, Rhode Island
Margaret A. Sun, M.D.
East Providence, RI
Thomas O'Toole, M.D.
Chief, Primary Care
Providence VA Medical Center
John Solomon, D.O.
FAAFP
Rhode Island Primary Care Physician's Corporation
Raymond P. Zarlengo, M.D.
Pediatric Medical Director,
Rhode Island Primary Care Physician's Corporation
