There’s No Overestimating Importance of Prevention

Prevention remains the mainstay of managed care, and this issue looks at it from different angles. The story explores how dental care affects overall health. Though the evidence is inconclusive, some major health plans have integrated dental and health benefits in unique ways. Dental health is seen as a factor in managing diabetes, coronary artery disease, pneumonia, and problem pregnancies.

Then there is alcoholism. If the secondary diagnosis of substance abuse is not recorded, the information will not be available in the data collection process. Many physicians are still hesitant to make that diagnosis, let alone force a discussion of it. The doctor may be uncomfortable, and of course, lecturing a patient could drive him away. Still, if anybody’s going to make the call, it will have to be the primary care physician.

Which brings us to our cover story. As Contributing Editor MargaretAnn Cross reports, the Council on Graduate Medical Education released a paper predicting a shortage of about 85,000 primary care doctors by 2020.

To prevent that from happening, the United States would have to train 3,725 family physicians and 714 osteopathic physicians annually, with an overall goal of a 39 percent increase in family physicians. Yet the number of primary care residencies offered this year to medical students fell by more than 100. And just 7.8 percent (1,107 persons) of medical students participating in the National Resident Matching Program selected primary care residencies, down from 8.1 percent (1,132) in 2006.

The main worry at health plans around the country is that a PCP shortage will leave members with complex or chronic medical conditions without anyone to coordinate their care. Prevention, again.

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