Primary care is the backbone of any high-performing health care system. It works best when primary care providers sit at the center of a patients’ health care experience and are aware not only of their medical needs but also of their social needs: Do they have food, housing, heat, a way to get to their appointments?
Coordinating what can be a complex nexus of specialty care and social services for patients is a challenge that physicians the world over are grappling with. Our survey of more than 13,000 primary care physicians in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States), published Tuesday in the journal Health Affairs, shows where the U.S. is falling behind, where we are keeping pace, and possible paths to improvement.
Primary care doctors in the U.S. and some other countries fall short in provider-to-provider communications and in exchanging patient information electronically. Only about half of U.S. physicians reported that they are usually notified when one of their patients is seen in the emergency department or admitted to a hospital. Compare that with 79% to 85% of physicians in the Netherlands and New Zealand who reported usually receiving these notifications.
About half of U.S. physicians reported being able to exchange patient information, such as clinical summaries, laboratory tests and medication lists, with physicians outside their practices. In contrast, 72% to 93% of physicians in the Netherlands, New Zealand, Norway, and Sweden reported these abilities.
On a brighter note, U.S. physicians were the most likely to report offering patients electronic access to their health care information through portals and web tools that enabled them to make appointments, refill medications, and see visit summaries and lab tests online. These patient-facing electronic services reflect the priority the federal government has placed on giving patients access to their health care information to achieve nationwide interoperability.
Primary care physicians in the U.S. and their counterparts around the world share significant challenges helping patients meet their health-related social needs. In most countries, physicians said they found it challenging to coordinate with social service providers to assure patients have things like good food or a living environment that accommodates their illnesses or disabilities. In the U.S., about one-third of physicians said that inadequate staffing, poor responses from social service agencies, or a lack of formal referral systems made it difficult to help provide patients with critical non-medical health-related services.
Here are three key strategies we identified that could help primary care physicians in the U.S. catch up with their counterparts elsewhere and better meet their patients’ diverse needs.
Vigorously enforce new federal regulations that require health care organizations to exchange health care information. Many primary care physicians work in large health care systems that may not have invested in or prioritized information exchange. The federal government has new regulations that, if properly enforced, could clear away some of the technical and economic barriers to passing information among physicians and other health care providers.
Develop payment systems that cover the costs of providing social services that are essential to medical care. A good example of this is medically prescribed foods for people with diabetes, which have been proven to be effective in reducing costs of care.
Share savings with social service organizations when their work with primary care physicians results in health care savings. Social service organizations often operate on shoestring budgets compared to better-endowed health care providers and cannot uphold their end of the care coordination partnership unless they have better staffing and information systems.
The U.S. lags most of the world in making primary care a top priority. That said, it has strengths to build on — nearly all primary care practices in the U.S. have electronic medical records, and providers, health systems, and payers see the value of supporting patients’ unmet social needs and are looking for the best ways to support them.
A strong emphasis on primary care across our health care system and continued benchmarking of U.S. health care performance against that of other wealthy nations will point us to a higher-performing health system.
Michelle Doty, Ph.D., is vice president of survey research and evaluation for the Commonwealth Fund. David Blumenthal, M.D., is president of the Commonwealth Fund.