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RESEARCH AND PRACTICE |
The author is with the Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Mass.
Correspondence: Requests for reprints should be sent to Anthony L. Schlaff, MD, MPH, Department of Public Health and Family Medicine, M&V 124, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111 (e-mail: anthony.schlaff{at}tufts.edu).
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ABSTRACT |
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 TOP ABSTRACT References |
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Coalitions are necessary for successful political change. Few national primary care provider organizations partner with community, consumer, or labor organizations, and very few do so to promote policy on access to health care. Many of these provider organizations do work on health care access policy issues and do work in partnership with a variety of organizations, suggesting that community–provider partnerships may be a promising but overlooked strategy for promoting health care reform.
The US health care system remains in crisis.1–3 Reform is necessary, but the political will to undertake such reform is lacking. Previous efforts, most notably that by President Clinton, have failed despite initial public support, in part because of organized opposition by interest groups who controlled the framing of the debate.4,5 Major policy change at the national level requires political alliances that can effectively counter such opposition.6–8 Communities and health care providers, particularly primare care providers, share a common interest in a health care system that delivers accessible, appropriate, and affordable care to communities. Together, they could forge an alliance that might finally create the conditions for reform.
Community groups need allies within the system so that they can better inform the public they represent and better respond to attacks on reform proposals by interest groups. Primary care providers who are committed to expanding access to health care must understand that the general public does not see them as allies. These providers must be better informed if they are to understand the values that communities seek to bring to the health care system.9 Much of the public misperceives the primary care system because most public debate about primary care has focused on the potentially negative notion of gatekeeping rather than on the positive attributes of a primary care system.10 If either of these groups is to accomplish what they want politically, they will need to find each other!
Because of changes in health care delivery, in attitudes, and in politics, coalitions between providers and consumers may be possible.11–13 Primary care providers, and the organizations that represent them, are perhaps increasingly aware that the current system protects neither their professional interests nor those of their patients. Furthermore, there may be growing realization that major policy remedies are necessary and that the political interests of primary care providers and consumers are not opposite but may, in some respects, be complementary.
A review of Web sites and a telephone survey of national organizations that represent primary care providers (Table 1
) suggested that only a small minority of national primary care organizations are partnering with community, consumer, or labor organizations to promote access to health care (Table 2). Most of these national organizations do not have, and appear not to plan for, significant strategic political alliances with community, consumer, or labor groups.
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In summary, coalition is necessary, the need for policies to provide access is critical, professional and consumer groups work together on a variety of other issues, and these groups have a common interest in policy to improve health care access. However, they tend to work on this issue in isolation from one another.
The lack of health care reform partnerships between community and primary care provider organizations raises several questions for research:
Provider organizations have a professional culture that may make alliances with community and consumer groups difficult to conceive, develop, and maintain.22 Provider organizations lack experience and training in coalition politics. Providers, particularly physicians, are trained as scientists—to believe that each question has only 1 correct answer. They receive little or no training in advocacy or policy and are socialized to see themselves as socially and intellectually separate from the people they care for. Although providers have been able to form partnerships with community groups on public health and service delivery issues, it may be difficult for them to trust in partnerships with communities regarding issues that ultimately will control their work environment and earning power. If such partnerships are to form, providers will likely need a great deal of training and support.
Given the promise of such partnerships, efforts to better understand and support them should be encouraged.
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Acknowledgments |
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I thank Howard Abramson, who assisted with the design of the data collection and the data analysis instruments, and Snaltze Pierre and Michelle Mehta, who worked as research assistants, collecting and entering data.
Human Participant Protection
This study was approved by the Tufts–New England Medical Center institutional review board.
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Footnotes |
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Accepted for publication November 28, 2004.
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References |
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TOPABSTRACTReferences |
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2. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
3. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.
4. Mechanic D. Failure of health care reform in the USA. J Health Serv Res Policy. 1996;1:4–9.
5. Vladeck B. Universal health insurance in the United States: reflections on the past, the present, and the future. Am J Public Health. 2003;93:16–19.
6. Longest BB. The context and process of public policymaking. In: Longest BB, ed. Health Policymaking in the United States. 2nd ed. Chicago, Ill: Health Administration Press; 1998:31–61.
7. Kingdon JW. The policy window, and joining the streams. In: Kingdon JW, ed. Agendas, Alternatives, and Public Policies. New York, NY: HarperCollins College Publishers; 1995:165–195.
8. Hoffman B. Health care reform and social movements in the United States Am J Public Health. 2003; 93:75–85.
9. Cary AH, Goldberg B, McDaniel S. Consumer views of primary care: an agenda for action. Am J Nurse Pract. 2003;7(10):9–23.
10. Safran DG. Defining the future of primary care: what can we learn from patients. Ann Intern Med. 2003;138:248–255.
11. McCormick D, Himmelstein D, Woolhandler S, Bor D. Single-payer national health insurance: physicians’ views. Arch Intern Med. 2004;164: 300–304.
12. Starfield B, Simpson L. Primary care as part of US health services reform. JAMA. 1993;269: 3136–3139.
13. Shearer S, Toedt M. Family physicians’ observations of their practice, well being, and health care in the United States. J Fam Pract. 2001;50: 751–756.
14. Rosner D, Markowtiz G. The struggle over employee benefits: the role of labor in influencing modern health policy. Milbank Q. 2003;81:45–73.
15. Families USA: The Voice for Health Care Consumers Web site. Available at: http://www.familiesusa.org/site/PageServer. Accessed June 25, 2004.
16. Services Employees International Union Web site. Available at: http://www.seiu.org. Accessed June 25, 2004.
17. Health Care for All home page. Available at: http://www.hcfama.org. Accessed June 25, 2004.
18. Consumers Union Web site. Available at: http://www.consumersunion.org. Accessed June 25, 2004.
19. Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Annu Rev Public Health. 2000;21: 369–402.
20. Metzler MM, Higgins DL, Beeker CG, et al. Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships. Am J Public Health. 2003;93: 803–811.
21. Nicholl J. Tobacco tax initiatives to prevent tobacco use: a study of eight statewide campaigns. Cancer. 1998;83(suppl 12):2666–2679.
22. Eng E, Salmon ME, Mullan F. Community empowerment: the critical base for primary care. Community Health. 1992;15:1–12.
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