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Over the last decade, healthcare spending has increased dramatically all over the world. In 2002, the USA spent 15% of its gross domestic product (GDP) on healthcare. By 2013, this figure had jumped to 18%. At this rate, the USA will be spending 34% of GDP on healthcare by 2040.1 This precipitous increase in spending is not unique to the USA, and neither is the search for a solution. Across the globe, countries are looking at delivery system reform as a way to hold down costs while maintaining quality.
The Patient-Centered Medical Home (PCMH) is one care delivery system which has been suggested as a possible solution to this dilemma in the USA.2 The PCMH is a primary care model designed to improve continuity, access, and team-based coordinated care (box 1). However, controversy remains as to whether the PCMH model has been successful, with some studies showing improved outcomes3 ,4 and others no difference.5 ,6 As delivery system reform continues to be developed and trialled across the globe, such as the recent reorganisation of primary care spending in the UK's National Health Service, it is critically important to understand whether the PCMH model in the USA will improve outcomes to save money or whether it will become a sinkhole for spending. If successful in the USA, the PCMH model could have implications for other delivery systems worldwide.
Elements of the patient-centered medical home
▸ Patient-centered access: appointments, 24/7 clinical advice, electronic access
▸ Team-based care: continuity, team care …
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