One of the weaknesses of current U.S. health reform efforts is that they are counting on the idea that primary care doctors will continue to exist.
Witnesses delivered that message today in Washington at a hearing on the future of primary care that was organized by the Senate Health, Education, Labor and Pensions (HELP) primary health and aging subcommittee.
Dr. Claudia Fegan, chief medical officer at the John H. Stroger Jr. Hospital in Chicago, said she sees hundreds of people line up across the street at a walk-in clinic affiliated with the hospital every day.
Chicago residents “stand in line in the wee hours of the morning, hoping to be one of the 120-200 people who will be seen that day and, even better, hoping to be one of the 12 patients who will be assigned to a primary care physician and given an appointment so they won’t have to come back,” Fegan said, according to a written version of her remarks posted on the committee website.
The Patient Protection and Affordable Care Act of 2010 (PPACA) “promises to provide insurance coverage to more Americans, but I know there will still be 30 million people who will remain uninsured even after the Affordable Care Act is fully implemented,” Fegan said. “So I know the need for the safety net and places like Cook County will remain.”
There certainly still will not be enough primary care providers to care for all the patients who will need them, Fegan said.
The huge holes that already exist in the U.S. primary care network led to the current influenza epidemic flooding hospital emergency rooms with patients who should have been seeing primary care doctors, Fegan said.
Dr. Andrew Wilper, a medical school professor in Boise, Idaho, testified that the federal reimbursement formula system now pays primary care physicians about 30 percent to 60 percent less than it pays specialists.
In Massachusetts, a state that already has enacted a health insurance access expansion program, one result is that the coverage access program has led to an 82 percent in the length of time patients must wait to see primary care doctors, Wilper said.
“Without payment reform, it is unlikely that efforts targeting medical students and residents will succeed in bolstering the primary care workforce,” Wilper said.