The future of primary care in a managed care era.
Health care reform in the United States and elsewhere raises many questions about equity and effectiveness of health services. Although the impetus has been cost containment, the reforms have often been justified on the grounds that they will enhance primary care. In this article, health care reform efforts are divided into two types: market-driven, demand-based systems versus systems predicated on meeting population health needs. The two "scenarios" are contrasted with regard to their likely impact on the attainment of primary care characteristics: first-contact care, longitudinality, comprehensive services, and coordination. Since the ultimate outcome of these reforms cannot be predicted, there is compelling need for evaluating them as they proceed.
Starfield
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Department of Health Policy and Management, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205-1996, USA.
D003363:Cost Control / Q000639:trends; D005069:Evaluation Studies as Topic; D005544:Forecasting; D018166:Health Care Reform / Q000191:economics / Q000639:trends*; D006301:Health Services Needs and Demand / Q000191:economics / Q000639:trends; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000639:trends*; D011320:Primary Health Care / Q000191:economics / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000639:trends; D014481:United States