The replacement of health authorities by primary care trusts in 2002 marked the beginning of a new chapter in the evolution of primary care in Britain's national health service. The explanations for these reforms include trying to improve the quality and accessibility of health services in the United Kingdom.1 How these objectives will be achieved has been intensely debated and, aside from the issue of resources, the question of how to foster the evolution of primary care in Britain remains unresolved.
Despite differences in how the United Kingdom and the United States finance health care and in the equity in the distribution of resources, the challenges in delivery of primary care are similar in the two countries. This first article in the series focuses on the current organisation of primary care in the United States. Future articles will describe the US experience with performance measurement in primary care, referrals to specialists, and innovations in delivering ambulatory care services.
- Although America and Britain differ in how they finance health care, many aspects of delivery of primary care are similar in the two countries
- Primary care is undergoing dramatic changes in America, as in Britain
- After increasing the use of gatekeepers in primary care during the 1990s, the US healthcare system is abandoning this model
- Occasional activities of many primary care physicians, such as care of inpatients and management of chronic medical conditions, are being concentrated in the hands of a smaller number of more specialised providers
- Strategies need to be evaluated to determine whether they in fact improve the quality and efficiency of the healthcare system.