Lifelong Health: Putting Primary Care First Is a Way To Fix Health Care

Recent research reports have shown that despite the enthusiasm around health care reform, every measure of our health is worsening. In the past few years, the prevalence of obesity has increased by 8 percent; the number of people who do the recommended amount of daily exercise has decreased by 10 percent; consumption of fruits and vegetables has decreased by 16 percent; smoking rates remain unchanged; and moderate alcohol intake has increased by 11 percent. The percentage of the population adhering to all "recommended lifestyle measures" has decreased by 15 percent. Particularly alarming is the observation that those who have had heart attacks, have high blood pressure or have diabetes are no more likely to commit to lifestyle changes than the general population is. We are in trouble. In those older than 20, 30 percent have high blood pressure; 30 percent are obese; 6.5 percent have diabetes; and more than 40 percent are totally sedentary. The problem is most severe in minorities, the poor and those without insurance. All of these statistics reveal people's complete lack of commitment to lead healthy lifestyles. It's no surprise that this lack of interest in health greatly increases risk factors for heart disease and stroke, which in turn account for the very high prevalence of preventable deaths. In 2002, more than 500,000 people died from coronary artery disease. Of those, 47 percent died before emergency services arrived or they were transported to hospitals. Had those people made it to hospitals, their risk of death would have been less than 10 percent. These alarming statistics are occurring despite vigorous efforts to make our population more aware of risk factors for disease and to encourage healthy lifestyles in our children, in ourselves and in the oldest of the old. Clearly, we are failing. Most alarmingly, it seems this is a uniquely American condition. Other developed countries around the world are making great progress in health outcomes despite spending much less on health care than the United States does. From my perspective, the difference is clear. Compared with other developed countries, the United States places a much lower priority on primary care and medically supervised prevention of disease. American physicians conduct more tests and more procedures in the evaluations of illnesses and tend to prescribe the most expensive medications. We are also more likely to deliver care that is of no proven benefit. Rather than a focus on primary care, our health care system is characterized by care that is delivered almost exclusively by specialists. The primary care physician is not valued, is reimbursed very little for his services, and must see so many patients a day that all he can do is triage and refer complex patients to specialists for further work-up and care. All of this greatly affects quality health outcomes and widens the gap between the U.S. health system and every other developed country's system. While some of the players in health care reform have voiced their commitment to primary care, I fear that the big business of medicine will overwhelm the real problems of American health care and lead to solutions that focus on more tangible areas of cost cutting. Most notably, a proposal already has been offered to cut physician reimbursement by 22 percent. Simply put, that would be a tragedy. Rather than fix the root problems of misallocated money and inappropriate focus on acute care, this sort of bottom-line policy would only result in more unnecessary tests and procedures while physicians struggle to make ends meet. Amid this gloom lies a glimmer of hope. Many leaders of the insurance industry have expressed a commitment to supporting "home physicians," who are primary care physicians who have the time and resources to comprehensively deliver quality care to patients. The home physician functions as a primary care specialist rather than as a triage physician, who refers any serious issue to a subspecialist. In concert with a team of nurses, physician assistants, dietitians, social workers and exercise physiologists, the home physician can either prevent illnesses or identify and treat them early. Hospitalizations would be reduced, and outcomes would improve. By allowing the home physician to provide individualized, hands-on education to his patients, the chances of significant lifestyle changes certainly would increase. In the fight for health care reform, remember the primary care physicians; they are the key to better health. ======== Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.
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