Reform Proposal

Congress should pass legislation that imposes a tax on all services performed by a specialist. By imposing this tax, not only would it discourage citizens from receiving care from a specialist unless necessary, it would also create a large source of income that could be used to better fund Medicare and make it more accessible to those without health insurance. With the average cost per office visit to a specialist is roughly $81 as compared to $64 for a primary care physician (AAFP, 2010; Figure 3), a simple 2.5% tax could generate an extra $2 per office visit. In 2006 there were an estimated 66.6 Medical Specialty Office visits per 100 people and 59.8 Surgical Specialty office visits per 100 people (AAFP, 2010; Figure3). With the currently estimated population of the United States at 308,874,791 according to the US Census Bureau, that equates to 205,710,610 estimated Medical Specialty Office visits in the US in 2006 and 184,707,125 estimated Surgical Specialty office visits.

This tax would be applied by the government to all billings on services not considered primary care, which could then be passed on to the patient. This added funding would help the US ease the strain on the US budget and increase the money available for spending for Medicare. According to the Kaiser Family Foundation, spending for Medicare has grown at a slower rate than private insurance companies (KaiserEDU.org, 2010). If Medicare was more utilized, more Americans could have health insurance. The US government would be able to transfer that increased funding into either expansion for who is eligible for Medicare, which would in turn increase the number of Americans with insurance, public or private. This act would not only increase the amount of insured Americans, but by reducing the amount of uninsured Americans, costs would be reduced. Americans with insurance would not be forced to pay for uninsured Americans that still receive medical care. This would also reduce costs for insured Americans. This tax might also deter specialty care usage and promote primary care usage. If more Americas utilized primary care, more illness could be prevented, which would also reduced costs.

References

American Academy of Family Physicians (2010) www.afp.org. Accessed 3/14/2010.

US and world population clock. (n.d.). Retrieved from http://www.census.gov/main/www/popclock.html. Accessed 3/14/2010

US health care costs. (2010, March). Retrieved from http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358. Accessed 3/14/2010

Health insurance 2008 highlights. (2009, September 22). Retrieved from http://www.census.gov/hhes/www/hlthins/hlthin08/hlth08asc.html. Accessed 3/14/2010

Shi, L., & Singh, D. A. (2008). Delivering health care in America: a systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.

Health Care Reform-Primary & Outpatient Care

As emphasized before, primary and outpatient care is extremely important, if not the most important aspect of healthcare. Primary care serves as the foundation for health care and any health care reform. As shown, an increase of just one primary care provider per 10,000 individuals has shown to decrease mortality by 5.3% (County Health Rankings, 2010). Primary care physicians are central to any health care reform. Currently, there is a 20% increase in specialization by internal medicine residents resulting in less primary care providers (Riselbach, et al). The following table shows the percentages of medical school graduates who contemplated careers in generalist specialties (Petersdorf & Goitein, 1999).

We feel primary care can be greatly improved if more emphasis is placed on the medical school environment. Our health care reform, then, addresses an underlying cause to the imbalance between primary and specialty care services, which has contributed to an imbalance in the ratio of generalists to specialists (Shi & Singh, 2008). Our reform proposes solutions to help influence the career choices of medical students and physicians already in residency programs (Monegain, 2009). We feel primary care physicians should have effective incentives and be eligible to receive additional funding and support (Monegain, 2009). We feel much can be done to make the medical school environment friendlier to primary care, thus improving all aspects of primary and outpatient care. We suggest the following proposals:
1. Medical schools should devote significant sections of the curriculum to general and ambulatory experiences.
2. Student should also be exposed to strong generalist role models and mentors. There should be an increased emphasis on teaching general internal medicine.
3. Generalists should also be offered prominent positions within academic medicine, as chairpersons, deans, and committee members.
4. Medical schools should strengthen their primary care departments by improving research and fellowship training programs.
5. Financial incentives such as loan forgiveness should be established to encourage medical students to choose generalist careers (AAFP, 2010; Annual Residency Completion Survey 2008).


6. There should be an increase in the number of primary care tracks.
7. Most importantly we feel the size of subspecialty programs should be downsized. This can be done by limiting the number of applicants into specialty fields (Petersdorf & Goitein, 1999).


(AAFP, 2010; Michael Munger, M.D., examines a patient at his medical office in Overland Park, Kan.)

We feel the medical school environment can act to reduce the disparities among primary care and specialty care physicians by implementing our seven proposals. Many factors will be changed, primarily the medical education programs themselves. However, we do feel these changes will be cost effective for patients considering the median expenses per office-based physician visit (AAFP, 2010; Figure 1). These seven suggestions also improve access for the estimated 45 million individuals who are uninsured bringing health care closer to where people live and work (Shi & Singh, 2008). Not only does our reform improve cost and access, it will also enhance quality as primary care focuses on the person as a whole, whereas specialty care centers on particular diseases or organ systems of the body (Shi & Singh, 2008).

References

1. American Academy of Family Physicians (2010) www.afp.org. Accessed 2/26/2010.
2. County Health Rankings (2010) Access to Care. www.countyhealthrankings.org. Accessed 2/26/2010.
3. Monegain, B. (2009, February 4). Docs say primary care physicians central to healthcare reform. Retrieved from http://www.healthcarefinancenews.com/news/docs-say-primary-care-physicians-central-healthcare-reform.
4. Petersdorf, R.G., & Goitein, Lara. (1999). The Future of internal medicine. Annals of Internal Medicine, 119(11), 1130-1137.
5. Rieselbach, R.E., Crouse, B.J., Frohna, J.G. (2009) Teaching Primary Care in Community Health Centers: Addressing the Workforce Crisis for the Underserved. Annals of Internal Medicine.
6. Shi, L., & Singh, D. A. (2008). Delivering health care in America: a systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.