Bringing it all back home: can Europeans learn from recent moves toward the medical home in US primary health care reform?

Abstract

As its health care system undergoes reform, most observers would agree that US primary care is fragmented and uncoordinated. Instead of being provided by a medical generalist in a context of continuity, it has traditionally been provided by specialists, particularly from internal medicine or paediatrics. This has been considered a major driver of rising costs in the US system. Minor conditions are seen through the lens of specialty-focused care, which can lead to over-testing and over-treatment by anxious specialists, untrained in the arts of laid-back watchful waiting, gate keeping and continuity of care. These shortcomings of US primary care have recently been documented by Schoen and colleagues1 in a survey of primary care in 11 countries. We quote: ‘although the United States spends far more than the other countries do, US primary care physicians continue to lag well behind in health IT capacity, are the least likely to have arrangements for after-hours care, and report few incentives or targeted support for improving primary care’. However, … Correspondence: Aileen Clarke, Professor of Public Health & Health Services Research, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. tel: +44 (0) 24 761 51060, fax: +44(0) 24765 28375, e-mail: aileen.clarke{at}warwick.ac.uk