The COVID-19 pandemic has reminded us what really matters in health care and has exposed the problems in our health system. We have underfunded our public health system and were left vulnerable when we needed it most.
Ten percent of our population is uninsured and suffered the most from the ravages of the pandemic. We have undervalued the importance of good primary care in controlling chronic diseases such as diabetes, hypertension and heart disease that left people with these conditions targets for severe COVID-19 infections.
The National Academy of Sciences, Engineering and Medicine recently published a detailed study of the American health system. The report titled “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” concluded that “primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.”
We currently spend only 5% of our $3.8 trillion health budget on primary care, compared to the 14% most other industrialized nations spend. We have much worse health outcomes in nearly every measure, despite spending nearly twice the per capita amount on health care compared to our peer nations.
Primary care focuses on the total health care of an individual with an emphasis on prevention of problems. Immunizations are one of the best examples of services with low cost and high value, as we have seen with the COVID-19 vaccines. Vaccines are routinely given in primary care offices for prevention of influenzae, pneumonia and other diseases.
COVID-19 vaccines should be available in primary care doctors’ offices, since many reluctant people can be convinced to get the shot by a doctor or nurse that they know and trust. This might help get us to “herd immunity” and blunt the effect of the threatening Delta variant of COVID-19.
A comprehensive primary care team includes doctors, physician’s assistants, nurse practitioners, nurses and medical assistants. Ideally it should include a mental health professional and a nutritionist. Having a mental health professional embedded in this “medical home” is particularly helpful, given the lack of availability of psychological counseling services and the barriers to obtaining them. Similarly, nutrition counseling is a vital component of good medical care and leads to improved wellness.
We have an opportunity in Virginia to make needed improvements in our health system, since $4.3 billion are coming to us from the federal government as part of the American Rescue Plan. Additionally, Virginia has a budget surplus this year of $2 billion, and thus more than $6 billion is available for many worthy causes.
Absolutely money should be used for expanded broadband access, mental health and support for small businesses. Since the health of our citizens is of paramount importance, using some of these dollars to provide better access to health care to the 648,000 uninsured Virginians makes sense.
The Virginia General Assembly will meet again in August to decide how to spend this money. I propose that some of it be spent to bolster the primary care system in Virginia, which evidence clearly shows will improve the health of our population. We can increase funding for the existing Virginia State Loan Repayment Program, which provides loan forgiveness for health professionals who choose primary care careers and serve for two years in underserved areas.
Additionally, some money could be spent on programs to place nutritionists in selected “medical homes” around the state. A good place to start is in primary care residency training programs that don’t have these services. Residents who learn in a comprehensive “medical home” are more likely to implement the same model where they eventually practice. Physicians who learn nutrition counseling from an expert would greatly contribute to improved health for their future patients.
Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 19 years teaching family medicine, most recently at Eastern Virginia Medical School in Norfolk.
