The Time Is Now: The Case for Transforming Primary Care.

Abstract

B Y NOW THE FACTS are well known. The United States spends far more on healthcare than any country in the world (20% of GDP), and ranks last among high-income countries in access, administrative efficiency, equity, and health outcomes. We have the highest infant mortality and lowest life expectancy. Even compared with many lower-income countries, we perform poorly (Doty et al., 2019; Kurani & Wager, 2021; Schneider et al., 2021; World Health Organization, 2017; World Health Organization, 2022a). Our care is fragmented, focused on disease rather than prevention and wellness, and is less safe than other developed countries. Feefor-service payment structures incentivize volume at the expense of quality and innovation while inhibiting team-based care. Fee-for-service has a particularly pernicious effect in primary care, where resulting time pressures undermine patient relationships,