Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1995 Aug;45(397):433–437.

Primary care and the maelstrom of health care reform in the United States of America.

P Curtis 1
PMCID: PMC1239339  PMID: 7576850

Abstract

Recent reform in the National Health Service has moved general practice towards a more intense market and competition structure. Meanwhile in the United States of America there has been an attempt to modify the free enterprise approach to medical care towards a more socially responsive system. This discussion paper provides a family doctor's perspective of primary care and the maelstrom of health care reform in the USA. The cultural, economic and organizational issues underlying the need for reform are considered in turn, and the current situation with regard to health care provision, medical research, medical education and primary care are outlined. General practitioners in the United Kingdom would do well to pay attention to the effects of market reform occurring in general practice among their American counterparts.

Full text

PDF
433

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Angell M. Privilege and health--what is the connection? N Engl J Med. 1993 Jul 8;329(2):126–127. doi: 10.1056/NEJM199307083290210. [DOI] [PubMed] [Google Scholar]
  2. Bertakis K. D., Robbins J. A. Gatekeeping in primary care: a comparison of internal medicine and family practice. J Fam Pract. 1987 Mar;24(3):305–309. [PubMed] [Google Scholar]
  3. Budetti P. P. Achieving a uniform federal primary care policy. Opportunities presented by national health reform. JAMA. 1993 Jan 27;269(4):498–501. [PubMed] [Google Scholar]
  4. Christakis N. A., Jacobs J. A., Messikomer C. M. Change in self-definition from specialist to generalist in a national sample of physicians. Ann Intern Med. 1994 Nov 1;121(9):669–675. doi: 10.7326/0003-4819-121-9-199411010-00008. [DOI] [PubMed] [Google Scholar]
  5. Cohen J. J. Transforming the size and composition of the physician work force to meet the demands of health care reform. N Engl J Med. 1993 Dec 9;329(24):1810–1812. doi: 10.1056/NEJM199312093292412. [DOI] [PubMed] [Google Scholar]
  6. Curtis P., Pathman D. The return of the generalist physician. Initiatives of the University of North Carolina School of Medicine. N C Med J. 1993 Sep;54(9):469–474. [PubMed] [Google Scholar]
  7. Deber R. B. Canadian Medicare: can it work in the United States? Will it survive in Canada? Am J Law Med. 1993;19(1-2):75–93. [PubMed] [Google Scholar]
  8. Diosegy A. J., Simpson S. D. Physician/hospital organizations. Integrating the delivery of health care. N C Med J. 1994 Jan;55(1):22–25. [PubMed] [Google Scholar]
  9. Dixon J. US health care. I: The access problem. BMJ. 1992 Oct 3;305(6857):817–819. doi: 10.1136/bmj.305.6857.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Franks P., Clancy C. M., Nutting P. A. Gatekeeping revisited--protecting patients from overtreatment. N Engl J Med. 1992 Aug 6;327(6):424–429. doi: 10.1056/NEJM199208063270613. [DOI] [PubMed] [Google Scholar]
  11. Geyman J. P., Hart L. G. Primary care at a crossroads: progress, problems, and future projections. J Am Board Fam Pract. 1994 Jan-Feb;7(1):60–70. [PubMed] [Google Scholar]
  12. Goldfield N. The looming fight over health care reform: what we can learn from past debates. Health Care Manage Rev. 1994 Summer;19(3):70–80. [PubMed] [Google Scholar]
  13. Greenfield S., Nelson E. C., Zubkoff M., Manning W., Rogers W., Kravitz R. L., Keller A., Tarlov A. R., Ware J. E., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed] [Google Scholar]
  14. Hart J. T. The inverse care law. Lancet. 1971 Feb 27;1(7696):405–412. doi: 10.1016/s0140-6736(71)92410-x. [DOI] [PubMed] [Google Scholar]
  15. Kelly J. H., Thompson C. R. Who needs health care reform--and why. N C Med J. 1994 Jun;55(6):248–251. [PubMed] [Google Scholar]
  16. Moore G. T. The case of the disappearing generalist: does it need to be solved? Milbank Q. 1992;70(2):361–379. [PubMed] [Google Scholar]
  17. Randlett R. R. Results of the National Resident Matching Program for 1994. Acad Med. 1994 Jun;69(6):508–510. doi: 10.1097/00001888-199406000-00022. [DOI] [PubMed] [Google Scholar]
  18. Rivo M. L., Saultz J. W., Wartman S. A., DeWitt T. G. Defining the generalist physician's training. JAMA. 1994 May 18;271(19):1499–1504. [PubMed] [Google Scholar]
  19. Rust G. S., Fuller L. E., Sr Increasing the production of generalists: a computer simulation. Fam Med. 1994 Oct;26(9):563–568. [PubMed] [Google Scholar]
  20. Schiff G. D., Bindman A. B., Brennan T. A. A better-quality alternative. Single-payer national health system reform. Physicians for a National Health Program Quality of Care Working Group. JAMA. 1994 Sep 14;272(10):803–808. doi: 10.1001/jama.272.10.803. [DOI] [PubMed] [Google Scholar]
  21. Steinbrook R. Money and career choice. N Engl J Med. 1994 May 5;330(18):1311–1312. doi: 10.1056/NEJM199405053301813. [DOI] [PubMed] [Google Scholar]
  22. Stimmel B. The crisis in primary care and the role of medical schools. Defining the issues. JAMA. 1992 Oct 21;268(15):2060–2065. [PubMed] [Google Scholar]
  23. Swartz D. The politics of reform: public health insurance in Canada. Int J Health Serv. 1993;23(2):219–238. doi: 10.2190/JJGJ-NGHE-R2CL-H75A. [DOI] [PubMed] [Google Scholar]
  24. Weeks W. B., Wallace A. E., Wallace M. M., Welch H. G. A comparison of the educational costs and incomes of physicians and other professionals. N Engl J Med. 1994 May 5;330(18):1280–1286. doi: 10.1056/NEJM199405053301807. [DOI] [PubMed] [Google Scholar]
  25. Weiner J. P., de Lissovoy G. Razing a Tower of Babel: a taxonomy for managed care and health insurance plans. J Health Polit Policy Law. 1993 Spring;18(1):75–112. doi: 10.1215/03616878-18-1-75. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES