RE "ER visits, costs in Mass. climb" (Metro, April 24): High-performing health systems, with comprehensive primary care as their foundation, achieve better outcomes and care experiences and at a lower cost per person than the nonsystem we have in the United States. Comprehensive primary care is defined by patients who can say: I can get care when and how I need it; I have a primary care physician who knows me as a person; that doctor cares for the bulk of my needs; if I need care outside my doctor’s office, I know who to turn to; and my primary care doctor coordinates my care.
But this work is blocked by payment policies that make primary care a repugnant career choice and that punish primary care physicians for engaging in the full scope of comprehensive care. The solution is health reform, which requires three elements: Everyone has access; the money flow inside healthcare supports the desired health outcomes and the work it takes to get us there; the work of healthcare is redesigned to support the desired health outcomes. Massachusetts maintains a dysfunctional delivery system. It moved on the first element of reform without making a substantive move on the other two. The current plan was bound to result in an angry, disillusioned public and increased costs with no demonstrable improvement in health outcome.
If our nation continues on this trajectory, I predict a disappointed and angry public paying more for bad care in 2012.
Dr. L. Gordon Moore
The writer is a primary care physician.