Patients, physicians, nurses, employers, payers, and other players in the health care system are directly affected by the severe limitations of the current US health care delivery and reimbursement system. The future will be worse unless the root causes of this dysfunction are addressed. The symptoms are fairly clear and the data to support a diagnosis as well as potential therapeutic options are available.
Unwarranted variation1 in the delivery of care contributes to the lack of a relationship between what is spent on health care and the quality of the services delivered.2 Other countries that spend far less per capita on health care than the United States deliver care that is more equitable, effective, and efficient and is safer and more patient-centered than is provided in the United States.3,4 The United States is slipping further behind other countries in areas such as amenable mortality5 and ranks poorly compared with several other countries on important attributes such as access and safety.4 Research suggests that the presence and support of a robust primary care system is a major characteristic of an efficient and high-quality health care delivery. This has been demonstrated in other countries as well as in the United States.6
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 54
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.