Michael E. Miller, MD
Potential Conflicts of Interest: None disclosed.
Miller ME. Redesigning After-Hours Primary Care. Ann Intern Med. 2012;156:67. doi: 10.7326/0003-4819-156-1-201201030-00018
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Published: Ann Intern Med. 2012;156(1_Part_1):67.
TO THE EDITOR:
The editorial by Margolius and Bodenheimer (1) in response to the successful Dutch after-hours primary care model reviewed by Giesen and colleagues (2) does not mention several essential differences between the U.S. and Dutch health care systems that would make the process of adopting such a model in the United States difficult.
The Netherlands and most of Western Europe have invested in more developed primary care systems than the United States and seem to value primary care physicians more—there is a notably smaller salary gap between specialists and primary care providers in those countries. Specialty societies in the United States are adamant about not reducing their members' income to enhance that of the primary care sector. Health insurance is mandatory in the Netherlands, enhancing access and limiting out-of-pocket expense. Taking time off from work to see a physician is not as anxiety-provoking. Here, at least in Boston, extending office hours seems only to shift the time of regular patient visits from weekdays to evenings and weekends. Recently, “patient-directed” (that is, higher deductibles and copayment) insurance plans have led to more telephone calls during off hours to manage patient problems without an office visit, and its fee.
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