How should we pay for primary care?

There’s little doubt that strengthening our primary care system is a priority in health reform.

But how do we pay for it?

The WSJ’s Ben Brewer (via the WSJ Health Blog, which has an excellent discussion in the comments) comes up with a few ideas, and not all of them are going to go over smoothly.

One involves moving money earmarked for the Medicare Advantage program to fund primary care. Insurers will balk at that suggestion.

Another idea, often discussed here, is to “lower the Medicare pay scale for specialty care, lab tests and procedures,” and to “expand the use of non-physician personnel to deliver repetitive procedural care like colonoscopies.” That will meet significant specialist resistance.

Dr. Brewer rightly points out that importing foreign doctors is not a viable solution, as these physicians will not be immune to the disincentives that plague the generalist system, and soon enough, they will be looking for a way out as well.

Neither is pouring money into a national health information project, which does nothing for the delivery of care or the administrative burdens that currently accompany it.

The WSJ Health Blog conducted a poll on the topic, asking its readers how should primary care be funded. The results did not show one consensus solution, which the ACP’s Bob Doherty interprets as trouble, “and with 22% saying ‘primary care doesn’t need the money,’ the consensus for primary care may be weaker than it appears.”

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