health care workforce

The ideal mix should be 50% primary care, 25% specialty care and 25% hospital services. These numbers are ambiguous and based on following reasons.

Primary care costs less compare to seeing specialists or getting hospital services, and gives much better population health outcome. This has been pointed out by Barbara Starfield in “Is US Health Really the Best in the World?” 5 out of 7 nations in the top health ranking have strong primary care, which translate into better access to care. Though there is no record on the influence of specialty physician-to-primary care physician, “relatively superficial analyses suggest that the reverse may be the case (Starfield).” Primary health care includes general practitioners, health educators, health promotion and disease prevention services. On the other hand, specialty physicians focus on treatment with a specific specialized area of medicine, and demands high payment. Primary care physicians are more interactive with patient's overall health history. They are the main source of educators to good health behavior change in patients. In addition to general treatment, the level of intervention with primary care physicans in promoting health can result in much better population overall outcome. Therefore, primary care deserve larger potion of the mix system.

Specialty care and hospital services share equal weight in the system because hospital care relies on specialists and technologies. Specialty and hospital care should not be considered for lower proportion because they are part of the indicators of quality care in health systems. In the article, “It’s the Prices, Stupid: Why the US is so different from Other Countries,” Gerard Anderson stated that the overall health quality depends on the readily accessibility of health care to everyone in the society. The accessibility is associated with the availability of health resources, such as health workforce and productive services. When patients need medical attention, they should have adequate medical practitioners attend to them. With the focus on individuals, special care and hospital services can ensure prolonged life and thus improve the quality of life.

There are limitations on these distributions. Strong statistical data shows that the costs to health care can largely affect equal access to health care and effective allocation of resources, thus resulting on low quality of health care system. For example, Japan is second to US in available technology but still ranks the 1st among OECD countries, where US ranks 13th (Starfield). Canada ranks in the top 5 while their density in acute care hospital bed is more than US. When considering the amount of spending on health care based on GDP, Japan spends 7.8% of GDP and Canada spends 9.1% of GDP, where US spend 13.0% of GDP (Anderson). This shows that US is putting more financial investment but not getting deserved benefit on overall health. This indicates efficiency in allocation of resources and different dynamic of health provision.

Strictly looking at the workforce, to lower the cost of health care and maintaining the need of specialists and hospital cares, the ideal mix of system should be with majority in primary care and equal share between specialists and hospital cares.