Fundingfor Primary Care Training
Fundingfor Primary Care Training
Theescalating cost of care has been a major concern for several decades,but preventing progression of diseases to chronic stages can help thegovernment enhance population health and contain the cost of care.However, the shortage of primary care providers has been a limitingfactor for the achievement of the goal of preventing some of thecommon diseases (such as diabetes and hypertension) and promotingpopulation health (Bylsma, Arnold, Fortna & Lipner, 2010). Theshortage of primary care providers may be attributed to the lack ofinterest in the primary care profession among students and the lackof funds to finance education. To this end, a legislation thatauthorizes the government to finance training and education of theprimary care providers can play a critical role of reduce theshortage of primary care providers and promoting population health.This paper will address the effectiveness of the Affordable Care Actin funding the training of primary care providers.
Althoughthe training of the primary care providers was initially catered forby the Public Health Service Act, Titles VII and VIII, the AffordableCare Act authorized the training as well as the educational programsfor the primary care providers under P.L. 111-148 and P.L. 111-152(Frey, 2008). This authorization and the combination of theprovisions of the two Titles have allowed government to resolve thechallenge of the shortage of the primary care providers in threemajor ways. The first strategy that has been achieved as a result ofenactment of the Affordable Care act is the expansion of the primarycare workforce. For example, the government utilized the provisionsof the ACA to invest $ 4 billion to promote the National HealthService Corps and $ 5.2 billion to expand the Graduate MedicalEducation program (GME) (U.S. Department of Health and HumanServices, 2015). The funds invested in the National Health ServiceCorp will facilitate the training of about 15,000 primary careproviders between 2015 and 2020 who are expected to serve a total of16 million patients while the GME program will facilitate thetraining of about 13,000 residents for a period of 10 years (HHS,2015). The success of this investment has been confirmed by a similarinvestment of $ 1.9 billion that was done between 2009 and 2014,which facilitated the training of a total of 20,500 primary careproviders, including nurses and doctors (HHS, 2015).
Thesecond strategy through which the ACA will contribute towards theeducation and training of primary care providers is the improvementof the current training programs. The purpose of modernizing thesepractices and training programs is to ensure that primary careprograms will acquire skills that can help them work efficiently andserve a large number of patients. Modernization will be accomplishedby strengthening the training infrastructure and creating newclinical training opportunities (HHS, 2015). The ACA providedincentives for health care facilities to train primary care providersin the community, which is the most effective way of promotingprimary health care practices. The health care facilities will onlypay for the resident’s salary while the government will take careof the salary of the teaching physician, unlike the previous scenariowhere the health care facilities paid all expenses of training careproviders outside the hospital’s facility. In addition, the ACAincentivized the state governments to pay for primary care servicesdelivered to patients with chronic conditions and residing in healthhomes (HHS, 2015). This will encourage the state to develop healthhomes that will train patients with chronic illnesses on how tomanage their own health, thus reducing the need for constant care ofprimary care providers. This will relieve some primary careproviders, thus easing the challenge of their shortage.
Thethird strategy involves the use of payment and incentives to attractmore students into the profession and retain the primary careproviders who are currently employed. For example, the ACA allowedthe government to give a 10 % Medicare bonus to health careprofessionals for whom primary care comprises of at least 60 % oftheir respective Medicare charges between 2012 and 2015 (HHS, 2015).This provision was included in the act to attract and encourage morehealth care professionals to focus on delivering more primary careservices. By attracting health care professionals into delivery ofprimary care and funding their further training through the GraduateMedical Education program, the government will be able to enhancepopulation health by focusing more on preventive care. An initiativedubbed as comprehensive Primary Care was launched in the year 2012 atcost of $ 322 million with the objective establishing collaborationbetween the private and public health care agencies, which has so farreached about 396,000 patients in need of primary care (HHS, 2015).In essence, providing more money to facilitate the work of primarycare providers and giving providers more incentives that are allowedby the ACA will help the government retains more professionals in theprimary care sector and to attract more students to pursue career inprimary care, thus addressing the ongoing challenge of shortage ofprimary care providers.
Theproblem of shortage of primary care providers
Theshortage of health care providers is an indication of an imbalancebetween the supply and demand for registered health careprofessionals. Trends indicate that the United States will continueto experience a significant shortfall in the number of primary careproviders if adequate measures are not taken to address the issue.Jacobson & Jazowski (2011) projected that the U.S. willexperience a deficit of 45,000 primary care providers by the year2010 and a shortfall of between 124,000 and 159,000 physicians by theyear 2015. This persistent shortage of providers of primary healthcare implies that patients have a limited access to a range of healthcare services that can protect them from chronic diseases.
Thepersistent shortage of primary health care providers can beattributed to several factors. The first major contributing factor isthe increase in the number of patients in need of primary health careservices, following the enactment of the Affordable Care Act. It isestimated that the Affordable Care Act allowed about 32 millionAmericans to access health care insurance, where primary health careis among the key services that are insured under the act (Jacobson &Jazowski, 2011). The drastic increase in the number of insured personputs the primary health care workforce under pressure because it hadto deliver the primary health care services to a larger number ofpatients. This phenomenon can be attributed to the fact that thenumber of insured patients increased at a higher rate compared to thenumber of primary care providers, which creates the need for trainingmore providers.
Secondly,the disproportionate growth in the national population versus thepopulation of health care professionals will continue to exacerbatethe issue of shortage of primary health care providers. Statisticsshow that the national population will increase at an average rate ofabout 0.8 % annually and the population of older adults aged 65 yearsand above will grow by 36 % in the next 10 years (Bodenheimer 2010and the Association of American Medical College, 2010). This impliesthat the U.S. will have an additional 50 million citizens andincreased proportion of older adults, who are more vulnerable todiseases. On the contrary, the population of primary care providersand physicians will grow at 7 % in the next 10 years, which willincrease the provider-to-patient ratio (AAMC, 2010). The largepopulation and the subsequent high number of patients will have alimited access to primary care since the number of health careproviders will be less.
Thethird factor is a significant decline in the number of studentsjoining colleges to pursue health care courses that lead them to theprimary health care profession. Bylsma, Arnold, Fortna & Lipner,2010) stated that one in every six general internists, who graduateto become primary health care providers drop the course beforegraduating. The loss of interest in the field of primary care isattributed to different factors, including the high cost of trainingthat leave students with debt by the time they graduate. A decline inthe number of students completing the college reduces the supply ofprimary health care providers, thus exacerbating the issue ofshortage. A combination of these demographic factors justifies theneed for an increase in funds for training more providers of primarycare services in order to curb the current shortage. The governmentfunded training programs will attract more students to the primarycare training program and reduce the number of students dropping thecourse as a result of financial constraints, thus increase the supplyof qualified providers of primary care.
TheACA addresses the issue of the shortage of primary care providers byincreasing funds for their training. By increasing the number ofgraduates who will serve as primary care providers, the act will haveallowed more patients to access primary care (Prina, 2015). Primaryhealth care is associated with an increase in patient outcome and animprovement in population health. According to Zerehi (2009) anincrease in access to primary care enhances patient outcome andreduce the rate of mortality. This is because patients can accesshealth care more frequently, which reduce the chances of progressionof diseases to chronic stages. Chances of recovering and keepinghealthy are higher when patients are in a constant or in a frequentinteraction with primary health care providers, which can only bepossible when the provider-to-patient ratio is low.
Inaddition, primary care shifts the focus of the health care systemfrom treatment to prevention of diseases. While other categories ofhealth care providers play the critical role of treating patients,primary care providers have more time with patients, which imply thatthey have more chances of diagnosing diseases at an early stage. Astudy conducted by Starfield & Macinko (2005) revealed thatstates with the high number of primary care providers reported a lessnumber of cases of obesity and substance abuse compared to stateswith a serious shortage of primary care professionals. Therefore, ACAwill maintain population health, reduce the cost of treatment, andenhance patient outcome by increase the number of trained primarycare providers. A decline in the cost of care as a result of theimplementation of the provisions of ACA can be associated with thefact that primary care providers are paid less than other specialistsand the treatment of diseases at an early stage costs less thantreating chronic diseases.
Althoughincreasing funds for training more primary care providers has a lotof benefits to the society, there are two major cons that mightreduce the effectiveness of ACA in addressing the shortage of thiscategory of professionals. First, the population has been increasingat an extremely high rate, and there is no guarantee that trainingmore physicians will resolve the current shortage (AAMC, 2010). Otherstudies have shown that primary care providers are not facilitatedenough to practice to their fullest and deliver safe and quality carejust like other groups of health care professionals (Hain, 2014).Therefore, training more primary care professionals who are notutilized to serve patients in need of primary care may be a waste ofpublic funds.
Secondly,there are high chances of trained primary care providers shifting toother groups of health care providers by way of advancing theireducation. According to Carroll (2015) many primary care providersconsider being a primary care provider as an entry level to thehealth care sector, which increase their probability to joining othergroups of professions. A similar study indicated that its only 54 %of the trained health care professionals would take the sameprofession if given another chance (Adams, 2012). This implies thatstudents who are enticed to select the primary care as theirprofession by paying the current workforce higher or paying theireducation fees may either change their career or fail to deliver tothe expectation of the government.Students who end up feeling thatthey selected the wrong career due to incentives offered under theACA may also affect the quality of care offered by the current healthcare system due to an increase in cases of medical errors.
Istrongly feel that increasing funds for training more primary careproviders is an effective strategy that can be used to reduceprovider-to-patient ratio and resolve the issue of shortage ofprimary care providers. An effective implementation of the provisionsof ACA can help the government achieve the desired ratio ofprovider-to-patient. The achievement of the desired number of primarycare providers will benefit the community and individual patients byincreasing the treatment outcome and helping them access preventivehealth care. The allocation of more funds to finance the education ofprimary care providers will reduce the college drop out of thiscategory of care providers and motivate more students to join theprofession since the fear of finishing college with huge debts willbe eliminated. However, I feel that policies and restrictions thatlimit the scope of work of primary care providers might reduce thecapacity of the government to achieve the desired population healthsince primary care providers are not given the opportunity topractice to their maximum. Although there are chances that someprimary care providers might change their profession after beingtrained, the number of providers who will continue offering primarycare is high enough to reduce the current shortage. It may not bepossible to eliminate the shortage of primary care providers, butfunding their training is an important step towards a viablesolution.
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