Market Watch: The Political Economy

Market Watch: The Political Economy of U.S. Primary Care, by Lewis G. Sandy, Thomas Bodenhelmer, L. Gregory Pawlson and Barbara Starfield

Despite the major technological developments and the significant growth of the specialty health care sector, the American health care system remains poor in comparison to other developed nations, due to the decay of the primary health care sector. The arguments of the four editors revolve around the analysis of the various forces behind this decline -- politics, economics and institutional forces.

After a relatively thorough examination of the three types of forces believed to be at the core of the decay in primary health care, the editors come to the realization that it is more than crucial to reform the American health care system. Their recommendations include the development of a five stage plan, called the 10x Program. Through this program, they advise the reaching of a balance between the primary and specialty sectors -- today for instance, more than half of the visits to doctors are made in the specialty field, rather than primary care providers. The 10x Program is expected to restore the balance, but in order to achieve its desiderate, intense attention must be paid to its five stages -- health care reimbursement, clinical workforce, medical education, health system performance measurement and practice infrastructure.

Throughout their analysis, the authors also introduce numerous political issues into the discussion. For once, they mention the poor implementation of workforce policies within the system. This discussion also took a new turn, in the meaning of revealing numerous wage discrepancies. With the introduction of the relative value scale, and then the relative value unit, workers in the field would be the recipients of different wages. The morality of such a decision is questioned by those health care employees, who feel less and less motivated. Additionally, a look at the insurance sector's approach to medical coverage was taken and the findings indicated that the insurance organizations do not cover for visits to primary care providers, but will however cover for more complex procedures, offered by specialty medical doctors.

Another example of policy approach is given by the editors' arguments that, in order to successfully implement the 10x Program and restore the balance between the primary and specialty care within the United States, a new policy approach is necessary. Its aim would be that of restoring the role and importance of a strong primary health care, as the basis of the entire American health care system. "To achieve U.S. health policy goals of accessibility, affordability, quality, safety and equity, a robust primary care sector must become the foundation of U.S. health care" (italics in the original text). But not only that this recommendation is linked to policy, it demands new regulatory measures to be taken. These regulatory measures will enhance the capabilities and role of the primary health care sector.