Kyle Bradford Jones: Medical system should put more energy into primary care

Not surprisingly, polls have shown that health care costs should be one of the top priorities for our nation to tackle. Given the time spent discussing it by 2020 presidential candidates, it certainly will remain atop the list of policy priorities for the foreseeable future.

Health care is expensive. We spend over $3 trillion a year for our care. Nearly 20 cents of every dollar we spend goes towards health care, the highest employment-providing industry in the United States. And it just keeps growing, at a rate faster than inflation, faster than wage increases, faster than the overall growth of our economy. We spend significantly more than any other country in the world.

Such cost could be somewhat justifiable if this spending led to significantly improved health, but it doesn’t. The U.S. ranks near the bottom of developed countries in health system efficiency, mortality from preventable diseases and overall health. We live shorter lives and our infants are more likely to die than other developed countries. The bitter pill of immense spending leaves us choking on health care’s failed promises.

The question of why we spend so much and are not much healthier for it is a very complicated one, with a myriad of potential solutions. The health care behemoth that currently exists in our country is immensely complex and no simple answer exists. That being said, there is significant evidence showing that the number one way to improve the quality of the care we receive for the cost is a greater reliance on primary care.

Primary care, which includes family physicians, internists, geriatricians and pediatricians, covers not only very basic health needs, but also very complex problems. Primary care physicians focus on prevention of significant health issues.

One of the biggest values of primary care comes from managing individuals with multiple chronic health problems, such as diabetes, heart disease, kidney disease, and others. The primary care physician helps the patient put everything together, seeing the whole individual and understanding how all of these diseases interact with one another, as well as in the context of the patient’s life circumstances, so as to optimize health. They also coordinate with the specialists to ensure that the care provided is consistent with all aspects of the patient’s health. This is an essential function in a convoluted and confusing health care system with many sick individuals.

Areas within the U.S. and in other countries that have a greater focus on primary care spend less on health care and achieve better outcomes. Places with a higher density of primary care physicians have lower rates of heart disease and stroke, fewer deaths from cancer, fewer hospitalizations and lower rates of smoking. Infant mortality improves, more people are immunized, people live longer, and fewer surgeries are needed. Patients with a primary care physician have up to 33% lower health care costs.

Primary care practices also increasingly work in broader teams to meet more of a patients needs, with professionals such as physician assistants and nurse practitioners, dietitians, pharmacists, mental health therapists and case managers, among others.

But our system as a whole under-incentivizes patients to see primary care physicians, and it discourages medical school graduates to choose it as a specialty. We face a shortage of thousands of primary care physicians over the next decade. Utah is 49th in the nation in its number of primary care physicians per capita, with 26 of 29 Utah counties being designated as primary care health professional shortage areas. This combines with Utah being the fastest-growing state in the nation to further exacerbate this scarcity.

Like the country as a whole, Utah’s population is aging and thus experiencing more chronic illnesses. More primary care physicians are needed to meet this increasing need.

If we are serious about lowering health care costs and getting more for our expensive investment, more emphasis on primary care is absolutely required. We call on third-party payers, legislators, regulators, and administrators to increase their dedication to a high-performing health care system that relies on primary care.

Kyle Bradford JonesM.D., FAAFP is currently the President of the Utah Academy of Family Physicians. Article was written for and first published in the Salt Lake Tribune.