The 27th National Conference on Primary Health Care Access Returns to Kaua'i

For the eighth time in 18 years, the Coastal Research Group will host the invitational National Conferences on Primary Health Care Access at the magnificent Grand Hyatt on the Garden Island of Kaua’i. The National Conference will take place April 4 through 7, 2016. Invitations and registrations forms will be mailed to invitees in July and August, 2015.

The theme of the 27th National Conference will be “What Comes Next?”.

A view of the South Pacific from the gardens of the Grand Hyatt Kaua'i
A view of the South Pacific from the gardens of the Grand Hyatt Kaua’i

The founding of the Coastal Research Group 32 years ago and the establishment of the National Conferences on Primary Health Care Access in 1990 were both based on the premise that the American health care system was in need of substantive reform.

Although there are many admirable features of American medicine, very serious deficiencies exist in how American health care is organized and financed.

Over the past 25 National Conferences, much of the discussion has not only identified what should be changed in the health system, but has assessed the intended and unintended consequences of past federal legislation (i.e, Medicare, Medicaid and the prescription drug benefit).

In 2010, the Patient Protection and Affordable Care Act (PPACA), to which the media have assigned the nicknames “ACA” and “Obamacare” passed and is currently in the process of implementation.

One threat to its orderly implementation was cleared away when the United States Supreme Court late in June 2015 rejected a challenge to the use of certain federal subsidies in states that had not followed specific procedures of the Act.

PPACA already has had a transformative impact on some aspects of the health care system. Yet, although the ACA, at the time of the 27th National Conference will have been enacted for more than a half-decade, its ultimate efficacy and impact is still a source of intense debate.

Whatever its ultimate impact, the problems that brought forth the National Conferences – the geographic and specialty distribution of physicians, the lack of a appropriately functioning system of primary care, the lack of effective integration of medicine and public health – all remain concerns.

These concerns are at the center of discussion of each of the National Conferences.

The Political Climate in 2015

The Patient Protection and Affordable Care Act has yet to gain the widespread popularity predicted by the legislation’s proponents.

The strategic decisions of the two political parties to stake their political fortunes on support or opposition to the act as a whole has made, at least for the time being, the legislative process for modifying the Act in any significant way seemingly unlikely.

A principal concern for the plans’ proponents would be if participating health care plans, as many predict, were to increase rates substantially to cover their costs, and if such cost increases were to erode ACA’s political support among the electorate in such a way to complicate the implementation process.

A Brief History of the Concept of Primary Health Care Resources

Fifty years ago, the treatise “Health Care is a Community Affair”, called the Folsom Report, was published. The next year (1965), the two principal federal programs for funding health care, Medicare and Medicaid passed, followed in the subsequent year, by the publication of the reports of the Millis and Willard Commissions.

The three reports and two financing mechanisms have had profound results, the former on development of public and private sector policies the latter on how the structure of American health care evolved.

The reports resulted in such familiar concepts as the idea of primary and tertiary health care, programs to address geographic and specialty mal-distribution of physicians, especially in rural and “inner city” areas, and creation of new primary health care personnel.

In the meantime, multiple efforts to address poverty in America at the federal level led to the creation of the Office of Economic Opportunity, which promoted such ideas as Neighborhood Health Centers.

With the change in administrations at the federal level in 1968, many of the OEO ideas were institutionalized (made politically more “acceptable”) in federal legislation supporting the Community Health Centers and the National Health Service Corps. Legislation funding the new primary care discipline of Family Medicine passed at the same time as the other “safety net” programs, that had consequences for the evolution of training the family physician.

The effects of the two financing mechanisms were outsized, impacting the structure and organization of any entity that received funding from either. Neither Medicare and Medicaid were developed in concert with the policy recommendations of the Commissions, and thus a half-century of accumulated evidence suggests that the policy bases of health care financing do not synchronize with the policy bases would underlie a rational American health care system.

Some issues for consideration by the 27th National Conference 

The following questions, all of which were posed for and discussed at the previous National Conference in Orange County, California, are posed for the faculty and invited participants for the 27th National Conference as well.

  1. What were the changes in American Health Care intended by passage of the “ACA”? To what extent have such changes been effected, with the likelihood that the change is permanent?
  1. Are there unintended changes that have occurred through passage of the “ACA”? Are those changes good or bad?
  1. Because Medicaid historically has differed significantly from state to state, ACA attempted to impose a more consistent approach to the financing of Medicaid recipients between states. To what extent has this effort been successful, and where do problems still exist?
  1. Insurance companies, which evolved historically to assess and contain risk, have been assigned the task of advancing the “rights” of health care recipients to care (who are now obligated to enroll in a health plan) while charging them with the plan’s actuarial costs. Is this the best way to increase access to health care?
  1. Has the “ACA” enhanced or impeded primary health care access in rural communities, and to “underserved” and disadvantaged populations? What is the anticipated impact of the November 2016 election on the ACA’s progress in providing care access?
  1. What are the effects of changes being implemented in the accreditation of medical schools and postsecondary physician training programs?
  1. How are such innovations as primary care medical homes, teaching community health centers, rural training tracks, hospital-centered community health plans, and accountable care organizations faring? Are there examples of programmatic successes (or failures) that would be of general interest?

Invitations to the 27th National Conference will be sent out in July and August, 2015. Those interested in the National Conference and the Invitation Conference should e-mail the conference coordinator, William H. Burnett, at [email protected]