Primary Care Advocacy Tool Kit

Call to Health Care Provider Groups and Consumer Groups!

We need to change the health care system to meet the needs of people and communities!

For more on provider-community coalitions:

• Key questions that communities must ask and answer
• The need for an honest critique of our health care system
• Solutions – National Debate and a Political Coalition of Patients and Providers
• Patients and Providers Together
• What Providers Must Do
• What Patients and Community Groups Must Do

Key Questions that Communities Must Ask and Answer

How can we determine what kind of health system people want, and then design such a system? Our original intent in the Futures papers was to propose a detailed and concrete agenda for building such a system using a primary care model. Given how far we are from a consensus on what our system should be, we do not think a comprehensive set of policy proposals is warranted.

Instead, we must engage in an honest critique of how far away our society is from being answering these key questions. These include:

1. What are the essential health services that all people in the community should have access to?
2. Who decides which services are needed?
3. How and in what setting are these decisions made?
4. What are the goals and incentives of the decision maker?
5. To whom is the decision maker accountable, and how is that accountability monitored and enforced?

The lost opportunity of the last decade is not just the failure to create universal access. There has also been a failure to create a language of public discourse, so that our communities can be prepared to take a careful look at what health care services can and should be offered, given their diverse values and priorities. Finally, three has been a failure to look outside our country and take an honest look at how other countries have developed flawed, but often workable, solutions to problems we still have not fully acknowledged.

The need for an honest critique of our health care system

How can such a critique occur? We do not believe this is a simple or short process. For every individual in society, health is a complicated, intensively important and personal, multi-dimensional attribute. Therefore, each individual should have a clear understanding of how the organization of health care services relates to his or her ability to protect and promote health. This in turn requires dialogue between those who provide health care and those who receive it.

Much is already happening. Across the country, there are community and consumer groups that organize and educate people about health and the health care system. Provider groups also exist that promote health system reform. Examples of coalitions between providers and patients can be found throughout the country. This toolkit is designed to encourage these coalitions, to urge providers and patients to join and participate in them, and to create them in localities where they do not yet exist.

Solutions – National Debate and a Political Coalition of Patients and Providers

Once providers and patient/consumer groups throughout the country have had opportunities to learn from each other, then political coalitions of providers and communities can be developed to advocate for system change. To many patients and community groups, providers appear to be politically indistinguishable from those who manage and pay for care. In reality their interests are different and should be much more closely aligned with those of consumer groups. Generally, patients and providers both want a system that places as much of the available resources and decision making with the patient/provider partnership. Many providers, however, have failed to take action or make statements that clearly signal to patients and communities that they are unabashed advocates on their behalf. Rather, they may appear more concerned with comfortable relationships with the profit and non-profit corporations that have assumed stewardship of the health care system. This failure may reflect a belief that providers have no power, or it may reflect a failure of will and abdication of responsibility to advocate. Regardless of its cause, this failure can and should be reversed.

Patients and Providers Together

Community and provider groups must be able to understand and trust each other in the political arena. Examples already exist and must be expanded. Providers and patients must discuss the implications that community desires and values should have on the design of a health care system. They must be able to inform policy makers about the questions they have raised and the answers that meet their needs. Together they should have the potential power to overcome the domination of health care policy by market forces and financial interest groups. This domination can be replaced by a social and community control of health care policy. With that control communities can allocate the resources necessary to implement that policy.

What Providers Must Do

Health care providers, particularly primary care providers, need to return to their roots as unabashed advocates for the interests of their patients. Providers also must do a better job understanding what patients want from the health care system, and they must stop defending parochial interests within the system. We call upon primary care organizations, individual providers, and health care educational institutions to clearly articulate their values, and to actively seek out patient and consumer groups to engage in dialogue.

What Patients and Community Groups Must Do

Patient and community advocacy organizations must be prepared to participate in a dialogue about health care choices. They must refuse to accept rhetoric and platitudes. They must come to understand some of the complexities of health care. In particular, that more, or more expensive, or more specialized care, is not necessarily better. They must come to understand that management of care, as opposed to management of cost of care, can actually be a good thing, done to protect patients and communities from over-treatment. They must understand, as must providers, that the days of medicine as a cottage industry are gone, and that, in the absence of a strong community voice in health care policy, the alternative to government oversight of health care is not provider autonomy and patient choice, but rather private corporate oversight and control of health care.