General practitioners added their voices to a growing call for health care reform in the United States on Monday with a proposal to completely change the way patients and their doctors interact.
The American College of Physicians suggested putting internists and family doctors at the center of patient care, paying them to coordinate prescriptions and specialists to help prevent disease and avoid unnecessary treatments.
President George W. Bush plans to address health care reform in his State of the Union address on Tuesday with ideas for tax breaks to help get coverage for some of the estimated 47 million Americans who lack health insurance.
Members of Congress are also making proposals, and last week the American Medical Association joined with consumer groups such as the AARP, which represents people over 50, and Families USA to propose their own plan to cover more people by extending federal programs and offering tax breaks.
The American College of Physicians, which represents 120,000 internal medicine physicians and medical students, said the changes need to go further. They said the U.S. system is costly and not always effective in part because there is no oversight of a patient's care.
"Expanding health insurance is essential. But it is equally essential that we reform the way that care is organized, financed and delivered in the United States," said Dr. Lynne Kirk, the group's president.
Specialists who generate many procedures are reimbursed more by private insurers and Medicare, and there are few incentives to keep patients healthy, said Robert Doherty, who manages government affairs and public policy for the ACP.
"If our recommendations are accepted, Medicare would no longer pay physicians based solely on how many procedures or visits are billed," Doherty said at a news conference.
"Instead, physicians would be paid for taking responsibility for coordinating the care of the whole patient," Doherty added.
For instance, doctors would be paid if they help a diabetic control blood sugar and thus avoid a foot amputation later.
NOT A GATEKEEPER
He said the proposed system goes far beyond the "gatekeeper" concept under which patients had to get permission from a primary care physician to consult a specialist.
"It's being done successfully in other countries," Doherty said -- citing Commonwealth Fund studies that show that health care quality in the United States often falls short of that seen in countries with nationalized programs, such as Britain, New Zealand and Australia.
In the United States, the Department of Veterans Affairs' used this model with success, Doherty said.
"Per capita health care expenses are considerably higher in the United States, and consume a higher proportion of the national Gross Domestic Product than other industrialized nations," the physicians' group said in a statement.
"Americans receive preventive and other health care less than half of the times recommended by evidence-based guidelines and often receive health care that is unnecessary, excessive and possibly even harmful."
The Physicians for a National Health Program and California Nurses Association/National Nurses Organizing Committee backed complete reform in bill introduced by Michigan Democratic Rep. John Conyers (news, bio, voting record) to create a national health insurance program.
Private industry weighed in with the launch of Revolution Health, an Internet-based health management system backed by AOL co-founder Steve Case and affiliated with his RediClinic centers that offer quick health services, such as consultations for ear infections and flu shots.
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