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Primary care is a model of health care that supports first-contact, accessible, continuous, comprehensive, and coordinated person-focused care. It aims to optimise population health and reduce disparities across the groups by ensuring equitable access to services for all subgroups.
Primary care is the day-to-day healthcare given by a health care provider. Typically, this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates any additional care the patient may require.World Health Organization. Definition of Terms. Accessed 24 June 2011. Patients commonly receive primary care from professionals such as a primary care physician (general practitioner or Family medicine), a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer (as in parts of Africa), or an Ayurveda or other traditional medicine professional (as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). Geneva. Accessed 24 June 2011. Common chronic illnesses usually treated in primary care may include, for example: hypertension, angina, diabetes, asthma, COPD, depression and Anxiety disorder, back pain, Osteoarthritis or Thyroid disease. Primary care also includes many basic maternal health and child health care services, such as family planning services and .
In context of global population ageing, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries.World Health Organization. Ageing and life course: Our ageing world. Geneva. Accessed 24 June 2011.Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. HealthLeaders Media, May 27, 2009.
Funding for primary care varies a great deal between different countries: general taxation, national insurance systems, private insurance and direct payment by patients are all used, sometimes in combination. The payment system for primary care physicians also varies. Some are paid by fee-for-service and some by capitation for a list of registered patients.
In 2017, the policy address recommended the establishment of a primary health care development steering committee to comprehensively review the planning of primary health care services and provide community medical services through regional medical and social cooperation.
The 2018 policy address proposed the establishment of the first district health centre and promoted the establishment of district centre in other districts.
The Hong Kong Food and Health Bureau established the Primary Healthcare Office on March 1, 2019, to monitor and supervise the development of primary health care services. In the process of developing the district health centers, regional health stations will be set up in various districts as transitional units offering the public with primary care services.
The basic health care unit (formerly: health care facility) is a medical entity that provides comprehensive care for people who have declared their willingness to use the services of a family doctor or another doctor who has the right to create an active list of patients. This means treatment and prevention of diseases, rehabilitation, as well as adjudication on the state of health. For a health care center to become a primary care provider, it must also provide care for its health visitor and midwife.
Since 2007, only General Practitioners, doctors undergoing specialization in family medicine, and doctors who have previously acquired the right to create an active list due to seniority in POZ before 2007 can be doctors creating active primary care lists. The currently pending proposals of the Ministry of Health, granting the right to create an active list to internists and pediatricians without experience of working in primary care, met with severe criticism of all family medicine organizations.
In organizational terms, POZ can act as:
The Act of October 27, 2017 on basic health care (Journal of Laws of 2020, item 172) has been in force since 2017.
POZ clinics are independent companies (except SPZOZ), however, the services they provide are free for insured persons when POZ has a contract with the National Health Fund.
Primary health care includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle, including reducing the level of risk factors for diseases, and sanitary and hygienic education. Primary health care is provided to citizens on an outpatient basis and in an inpatient setting, in planned and emergency forms.
Types of primary health care:
Primary medical health care is provided by general practitioners, district general practitioners, pediatricians, district general pediatricians and general practitioners (family doctors). Primary specialized health care is provided by specialist doctors, including medical specialists from medical organizations that provide specialized, including high-tech, medical care.
A 2009 report by the New England Healthcare Institute determined that increased demand for primary care by older, sicker patients and decreased supply of primary care practitioners has led to a crisis in primary care delivery. The research identified a set of innovations that could enhance the quality, efficiency, and effectiveness of primary care in the United States.
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law is estimated to have expanded health insurance coverage by 20 million people by early 2016 and is expected to expand health care to 34 million people by 2021. The success of the expansion of health insurance under the ACA in large measure depends on the availability of primary care physicians. The ACA has drastically exacerbated the projected deficit of primary care physicians needed to ensure care for insured Americans. According to the Association of American Medical Colleges (AAMC), without the ACA, the United States would have been short roughly 64,000 physicians by 2020; with the implementation of the ACA, it will be 91,000 physicians short. According to the AAMC's November 2009 physician work force report, nationally, the rate of physicians providing primary care is 79.4 physicians per 100,000 residents.
Primary healthcare results in better health outcomes, reduced health disparities, and lower spending, including on avoidable emergency department visits and hospital care. That said, primary care physicians are an important component in ensuring that the healthcare system as a whole is sustainable. However, despite their importance to the healthcare system, the primary care position has suffered in terms of its prestige in part due to the differences in salary compared to doctors that decide to specialize. A 2010 national study of physician wages conducted by the UC Davis Health System found that specialists are paid as much as 52 percent more than primary care physicians, even though primary care physicians see far more patients.
In 2005, primary care physicians earned $60.48 per hour; specialists, on average earned $88.34. A follow-up study conducted by the UC Davis Health System found that earnings throughout the careers of primary care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues. This discrepancy in pay has potentially made primary care a less attractive choice for medical school graduates. In 2015, almost 19,000 doctors graduated from American medical schools, and only 7 percent of graduates chose a career in primary care. The average age of a primary care physician in the United States is 47 years old, and one-quarter of all primary care physicians are nearing retirement.American Academy of Family Physicians (AAFP). Advancing Primary Care". Council on Graduate Medical Education: Twentieth Report. December 2010. Fifty years ago, roughly half of the physicians in America practiced primary care; today, fewer than one-third of them do.
Projections show that by the year 2033, the population of individuals 65 and older will increase by 45.1%, creating a demand for primary care physicians that is greater than the supply.
The medical home model is intended to help coordinate care with the primary care provider at the center of the patient's healthcare.
According to a FAIR Health analysis, 29 percent of patients who received medical care in the US between 2016 and 2022 did not see a primary care doctor.
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