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- Page navigation anchor for Primary Care Challenges and Commitments Across Different Health SystemsPrimary Care Challenges and Commitments Across Different Health Systems
To the Editor,
We read the paper by Rittenhouse and colleagues (1) with close attention, not only because of its careful mixed-methods design but also because its findings echo professional dilemmas we meet daily in Spain’s public National Health System (SNS). As family physician researchers with longstanding experience working in areas with deprived urban neighbourhoods and on short-term placements in sparsely populated rural areas (“zonas de difícil cobertura”), we recognise the portrait of clinicians who operate at the intersection of biomedical need and social disadvantage (2). Although our working contexts differ (the Spanish SNS offers tax-funded universal coverage and salaried employment within public primary-care teams) the challenges of serving communities that face poverty, linguistic barriers, insecure housing or violent environments resonate strongly with the experience reported in the United States study.
The inspiring article (1) from Rittenhouse team reminds us that the international evidence base has long described how robust, first-contact, longitudinal and person-centred primary care contributes to better population health, greater equity and lower costs (3). The National Academies’ 2021 blueprint to “rebuild” primary care frames these attributes as infrastructure requiring sustained policy attention (4). Europe’s comparative PHAMEU project reached similar conclusions, showing that countries with stronger primary-care orientation tend to per...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Data transformed into stories that matterData transformed into stories that matter
Here is a coherent story of an important subset of family practices in the US--an affirmation of the adage that we humans need words to know and stories to understand. Peering through the careful descriptions are revelations of small being beautiful, autonomy of a value-driven practice being sacred, medicine being a calling. From a policy perspective, perhaps one of the most important contributions of this research is claimed in the introduction with "In federal policy discussions, FQHCs have become synonymous with primary care for the socially vulnerable." At once this claim is something for which to be grateful--a place in federal policy making that makes a difference and should be protected, but also an indictment that leads to overlooking the large number of non-FQHC primary care practices making crucial contributions to the care of the under-resourced people in need. Where can one go to define and implement policies to enable the non-FQHC practices committed to meeting the needs of everyone in their communities? What agency identifies them, announces their needs, and agitates for policies to help them thrive?
Competing Interests: None declared.