Primary Care Physicians: Gatekeepers to Health Care Success

The medical community has long underestimated primary care physicians as doctors who have only a general knowledge of medicine. After reading Jerome Groopman’s novel How Doctors Think and various articles relating to primary care, I am convinced that universal access to primary health care is of dire need and importance to all societies. Reinforcing the important role that general practitioners play in moderating patients’ access to specialized care and reducing the financial burden of health care costs is crucial. By enabling greater access to primary care, society can expect better outcomes for population health and the health care system in the United States as a whole.

Alternatively known as “gatekeepers” to the medical field, primary care physicians serve as coordinators of care. They regulate patients’ access to specialists and help in early detection of preventable illnesses and diseases. Because the primary care doctor regulates where the patient can be referred, primary care has the ability to reduce unnecessary doctor visits, and thus, prevents unnecessary expensive visits to specialists. Primary care physicians also provide a more direct connection between physicians. Primary care doctors often serve as a portal for other specialists as they provide documentation of a patient’s medical history. This helps to increase communication among doctors, allow for quicker diagnoses, and lessen the burden of deciding upon his or herself for the best path for treatment. If primary care doctors did not monitor their patients’ care, patients would self-refer themselves to specialty doctors without a clear indication if visiting a specialist is actually necessary for their condition. As a result, precious time and money can be wasted. Primary care doctors serve as “gatekeepers” in situations where they feel a patient is in need of more specialized care. This sense of monitored care reduces the frequency of fragmented care and therefore increases the quality of care provided to patients by physicians.

If it is public knowledge that primary care doctors offer great financial and health benefits to patients, why do many Americans choose not to have a primary care physician? Surprisingly, many people feel that general practitioners do not have sufficient medical knowledge to properly diagnose. Instead, they would rather go to a specialist who specializes in a specific area of medicine. Additionally, one may choose not to visit a primary care doctor simply because he or she cannot afford the costs of health insurance, are not eligible for Medicare or Medicaid, or does not have enough money to pay for out of pocket expenses. Unlike in an emergency room setting where doctors must examine all patients, clinicians have the option of deferring those who have poor reimbursement histories and, or, do not have health insurance. Lastly, people may not choose to have a primary care doctor because they cannot readily access primary health care. The distribution of primary health physicians is largely based upon the socioeconomic background of a community. Physicians have the tendency to practice in regions where the vast majority of patients are able to afford the costs of doctors’ visits. This is problematic for many urban communities who are unfortunately not always able to pay out of pocket costs and cannot afford the costs of transportation to other communities that offer primary care.

Lack of primary health care is a concern for all people in the United States. Unnecessary visits to multiple specialists and to emergency rooms have adverse effects on both health infrastructures and society alike. In the event where a patient is unable to pay the costs for multiple visits to specialists or to hospitals, which individual(s) will pay the costs? If a patient, who does not have the money to pay out of pocket for health expenditures and does not have health insurance, is admitted to a hospital, the hospital will inevitably have to cover the health care costs. Too often have hospitals remained unreimbursed by patients who could have otherwise prevented a costly visit to the hospital by first seeing a primary care doctor. In a scenario where a patient has health insurance and pays unnecessary visits to specialists and, or, emergency rooms, excessive visits ultimately have a negative impact on other insurance holders within the same health insurance plan. Unneeded visits eventually result in increased premium costs for all insurance holders. These situations are only two contributing reasons why health care and health insurance is extremely expensive in the United States.

Providing affordable health care to a nation’s population is a controversial subject. The United State’s unorganized health care system faces constant national and international scrutiny for its inability to provide accessible and affordable quality care to the majority of its people. Inefficiencies in the United States’ health care system should not be solely blamed upon individuals who cannot afford the unbearable costs of health care and health insurance. Although modifying the health care system requires much further assessment, providing accessible primary health care to all American citizens will offer a better outcome for the overall population health and health care system in the United States.

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