Primary care in the United States: Innovations in primary care in the United States * Commentary: What can primary care in the United States learn from the United Kingdom?

摘要: # Innovations in primary care the United States {#article-title-2} It has been said that faces worst of times and best times.1 Why times? Primary was catapulted into prominence by advent health maintenance organisations; many such organisations' 80 million patients were required to gain permission from their physician access laboratory, radiology, specialty services. Because number people enrolled organisations is declining, more are free move around healthcare system. The may revert its previous dispersed system care, which enter specialty-dominated through a variety doors rather than single entrance. When moved central position they expected physicians do far for before,2 yet paid little more, if at all, these additional tasks. looking like “hamsters on treadmill” described an article BMJ .3 In California, proportion very satisfied with work dropped 48% 1991 36% 1996.4 past few years, medical students have become less interested making career because long hours, high stress, relatively low reimbursement generalist physicians.5 #### Summary points Primary facing difficult times: doctors overworked dissatisfied it, not it Primary unable deliver everything it offers neither timely acute nor state art chronic care A redesign sector addresses problems … Correspondence to: A Majeed