The U.S. Health Care System Isn’t Built for Primary Care

There is widespread agreement that the United States must expand and improve primary care in order to achieve better health outcomes at a lower cost. A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) published last May concluded that primary care is the only medical discipline where a greater supply produces improvements in population health, longer lives, and greater health equity. This growing consensus is a good thing.

But current efforts to wring “value” from primary care by focusing on diagnostic algorithms and quality metrics reveal fundamental misunderstandings of primary care’s purpose. The attempts to apply processes and technology designed for subspecialty care to the delivery of primary care have proven insufficient to support the complex work of the primary care team.