Primary care in the United States: Innovations in primary care in the United States * Commentary: What can primary care in the United States learn from the United Kingdom?

doi:10.1136/bmj.326.7393.796

BMJ 2003;326:796-799 ( 12 April )

Primary care

Primary care in the United States

Innovations in primary care in the United States

Commentary: What can primary care in the United States learn from the United Kingdom?

Innovations in primary care in the United States

Thomas Bodenheimer, clinical professor.

Department of Family and Community Medicine, University of California at San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA

tbodie@earthlink.net

The first 150 words of the full text of this article appear below.

It has been said that primary care in the United States faces the worst of times and the best of times.¹ Why the worstof times? Primary care was catapulted into prominence by the adventof health maintenance organisations; many of such organisations'80 million patients were required to gain permission from theirprimary care physician to access laboratory, radiology, and specialtyservices. Because the number of people enrolled in health maintenanceorganisations is declining, more patients are free to move aroundthe healthcare system. The United States may revert to its previousdispersed system of care, in which patients enter the specialty-dominatedsystem through a variety of doors rather than through a singleprimary careentrance.

When health maintenance organisations moved primary care to a central position in health care, they expected primary carephysicians to do far more for their patients than before,²yet they paid little more, if . . . [Full text of this article]

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