Primary health care began after the Alma-Ata international conference in 1978. The Alma-Ata Conference was an international conference in which government leaders worldwide came together to discuss health care problems and concerns. The fundaments of primary health care include four components: universal coverage, people-centered care, inclusive leadership and health in all policies.
Many supporters of primary health care point to the cost effectiveness of the system as an advantage, but there is some debate. Advocates believe that the hospital should not be a patient’s usual initial resort—rather, the patient should seek out a primary care doctor who can refer him to a specialist if needed. This would save initial costs for a consumer because a general primary care physician would be cheaper than a trip to the hospital, thus making the system more cost effective.
However, this would require a shift of care from a focus on specialists to emphasis on general practices and secondary-primary care. This restructuring of the system may mean that it would not necessarily be cost effective because of the costs it would require to make the switch. For example, according to numerous sources (including the New York Times and PBS) more doctors are choosing to become specialists in the United States, as opposed to primary-care physicians, because specialists are paid more on average.
To correct this problem, the government may have to finance more residency slots through Medicaid expenses. Additionally, salaries for primary-care physicians may have to be subsidized through Medicaid and other similar programs. This may make the program less cost effective as a whole.
High Patient Satisfaction
Supporters of primary health care identify high patient satisfaction as an advantage of the system. The ease of access to a doctor is a determining factor.
Despite the higher patient satisfaction that accompanies the primary health care system, opponents highlight the fact that the system disproportionately favors the poor over the middle class and rich. Because there is more investment in primary care versus hospitals, the individuals who receive the most benefit from the system are those with lower mortality and morbidity.
Advocates of primary health care also cite studies that show countries that use primary health systems have better health in the country as a whole. These studies take account of other variables that might affect average health, such as the percentage of elderly people in the population, the gross domestic product in relation to the population, the average income within the population, and the average alcohol consumption within the population, in order to make sure that it was the health care system itself being compared among countries and not all these other variables.
Even after the variables were accounted for, the results clearly showed that better health can be achieved through a primary care system.
Opponents identify the fact that defining “primary care” is incredibly difficult. Each country has a different idea exactly of what “primary care” entails. Thus, for larger countries—such as the United States—it can be incredibly difficult to determine even exactly how to apply the general principles of the system to health care.
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