Using Rocket Scientists to Fly Kites?

22 Sep

Proponents of health reform have long claimed that one of the biggest problems with our health care system is an overemphasis on expensive specialists and an underemphasis on primary care physicians–who, much research shows, produce high quality care at a much lower cost. In essence, the argument is that we’re using (and paying for) rocket scientists to fly kites. If we bolster the primary care workforce, suddenly we’ll start saving buckets of cash and people will not only be just as healthy–but they might actually start becoming healthier, as greater emphasis is placed on things like prevention, continuity of care, and chronic disease management.

To be fair, not every study supports the “more primary care is better” philosophy, but that hasn’t much mattered. It has become a central tenet of reform for most. Tom Ricketts and I actually authored a paper that raises some methodological concerns, which call some of the typical findings into question. (Warning: If you’re not accustomed to reading academic papers, this may not be for you.) But the most recent kicker comes from the folks at the Dartmouth Atlas who are well known for their work revealing the wide geographic variation in Medicare spending. The group recently released a report that, simply put, says primary care isn’t the panacea many people claim it to be.

What in the world is one to make of this?! Nothing really. Primary care practices don’t exist in a vacuum. People’s environments, their lifestyle choices and health behaviors still play a large role in their health outcomes. Furthermore, patients rely on both generalists and specialists, not generalists alone. The Dartmouth report doesn’t mean that primary care is suddenly more expensive than previously thought, or that it doesn’t provide the high quality of care it was once believed to. Rather, it means that there is no “magic bullet” that will suddenly solve all that ails our country’s health care system. Let me be as clear as possible about this: Primary care is a good thing–it’s just not the only thing. Now back to your regularly scheduled programming……


Posted by on September 22, 2010 in Uncategorized


2 responses to “Using Rocket Scientists to Fly Kites?

  1. Danno R

    September 22, 2010 at 10:54 pm

    Although I personally have no reason to question the Dartmouth study, I've read some comments elsewhere that raise a certain amount of concern – not much, mind you – that there may be some biases in their data. Do you have any thoughts on this question?

  2. D. Brad Wright

    September 23, 2010 at 1:55 am

    Danno–there is no such thing as bias-free research. That said, I think this most recent Dartmouth paper is actually more believable than some of their other work. In short, the very fact that they are painting a more cynical picture of primary care gives me hope that their findings are on target. I could go into more detail, but I need to work on my dissertation!


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