1992
Public Health Service
Primary Care Policy Fellowship

"Primary Care For High Risk Populations"

Anne Bader, M.N.
Administrator for Health Policy
Division of Primary Care
Agency for Health Care Policy & Research

Judy Ann Bigby, M.D.
Assistant Professor of Medicine
Brigham and Women’s Hospital

Larry Culpepper, M.D., M.P.H.
Director of Research
Professor of Family Medicine
Brown University

Junius J. Gonzales, M.D. *
Director
Clinical Services, Department of Psychiatry
Georgetown University Hospital

George D. Kent, Ph.D.
Executive Director
Northern Kentucky Family Health Centers, Inc.

Elaine Neenan, D.D.S.
Associate Dean for External Affairs - Dental School
Associate Professor
Department of Community Dentistry, University of Texas

Paul M. Paulman, M.D.
Associate Professor
University of Nebraska

* Presenter

Introduction

There is a pressing need to clearly articulate federal policy regarding programming for high-risk populations with special health needs. We define high-risk populations as those groups (such as Healthy People 2000’s special populations), which have individual or composite factors that predispose them to poor outcomes. One important factor that these high-risk populations often share is inadequate access to health care delivery, whether it be caused by individual, structural, institutional, or financing variables.

The Secretary has outlined a strategic planning document for the health of U.S. peoples – Healthy People 2000. We submit that the Healthy People 2000 objectives for special, or high risk, populations, can be met by a health care programming policy that uses primary care, rather than fragmented categorical health programs.

The Policy Statement

Programming for high risk populations’ health care needs will be built on, and supplement, a community-based primary care delivery infrastructure, rather than through categorical health programs which often operate in parallel to the primary health care system.

This Policy Has the Following Objectives:

  1. To move high risk populations into lower risk status;
  2. To minimize movement of people into high risk groups;
  3. To provide ongoing comprehensive primary care services to people in high risk populations;
  4. To ensure opportunities for these communities to participate with this care system in prioritizing and achieving their specific Healthy People 2000 objectives;
  5. And, finally, to maximize the effectiveness of federal primary health care programs.

The Benefits of this Policy have Health Care Cost, Access and Quality Implications:

  1. An example at the patient level is improved and more efficient access via this primary care system for various needs – the “one-stop shopping” proposed by the Secretary himself.
  2. An example at the provider level is improved quality of care delivered by continuous, coordinated care versus episodic, discontinuous and fragmented care.
  3. An example at the federal level regarding cost is optimal effectiveness of federal health care expenditures.

Conclusion:

We restate our recommended policy - that programming for high-risk populations’ health care needs be built on, and supplement, a community-based primary care delivery infrastructure, rather than through categorical health programs which often operate in parallel to the primary care system.

We also believe that this policy can indeed effect the seminal Healthy People 2000 Objective #21.3c:

Increase to at least 95 percent the proportion of low-income people who have a specific source of ongoing primary care for coordination of their preventive and episodic health care.

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