Publications by Stephen Schoenbaum for Health Policy Center

Back to Browse by Author

Primary care is essential to the effective and efficient functioning of health care delivery, yet we face an impending crisis due in part to a dysfunctional payment system. The paper proposes a new payment model to replace fee-for-service. A comprehensive payment would support health information systems and teams essential to the delivery of comprehensive and coordinated care. In theory, expecting-and paying-primary care physicians to take greater responsibility for patients as they encounter the health care system should result in higher quality and lower costs. Field tests of the new approach are needed to test the hypothesis.

In the current malpractice insurance crisis, physicians have focused their advocacy and energy primarily on rapidly increasing liability premiums, problems in access to care, and demands for legal reform, especially caps on damages. An even more important focus, however, is prevention of injury and improvement of patient safety. Physicians largely control patient care and can play a critical role in systematically reducing injury. Reforms should go beyond liability issues; they should also harness and enhance physicians' ability to act. More visible efforts by physicians to reduce harm, better communication with patients and others, and true evidence of improved patient safety should reduce patient anger and litigiousness. Individually and collectively, physicians can and should ensure that "doing no harm" comes first in the malpractice debate. (Annals of Internal Medicine 140(1): 51–53, 2004.)

Return to list of authors.