To encourage growth in the number of primary-care physicians, insurers and other payers should convert to capitation or increase fee-for-service payments to those physicians, a government panel has recommended.
The Institute of Medicine's committee on the future of primary care also recommended that efforts to increase the number of primary-care physicians be continued. The institute is a Washington-based government advisory organization.
The institute's primary-care report is its second this year on physician work-force issues. In January, the institute recommended steep reductions in federal funding of graduate medical education and the number of residency slots because of an oversupply of physicians.
The new report said a greater emphasis on primary care is key to the evolution of an efficient, high-quality healthcare system. Primary-care practitioners can treat a "large majority of health problems present in the population" while delivering better-quality care in lower-cost settings, the report said.
By moving to capitation, the report said, payers can encourage growth in the ranks of primary-care physicians because capitation encourages lower-cost primary- and preventive-care activities.
By comparison, the report said, fee-for-service payment increases utilization because it encourages physicians to increase the number of services delivered to patients, particularly higher-cost specialty services.
In contrast to the institute's report on overall physician supply, the primary-care report found a slight shortage in the number of primary-care physicians, physician assistants and nurse practitioners.
The primary-care report recommended continuing existing efforts to encourage physicians and medical students to enter primary-care specialties, as well as:
Requiring that medical students undergo some training in primary-care settings and dedicating a portion of Medicare graduate medical education payments to primary care in nonhospital settings.
Developing an all-payer system to finance primary-care training.
Changing state "scope of practice" laws that restrict what physician assistants and nurse practitioners are permitted to do.
Researching ways in which managed-care and integrated healthcare systems can improve distribution of primary-care practitioners in under-served areas.