The federal government would have the implementing responsibility for Recommendation 8.4, and the committee expects that a collaborative effort involving the agency designated for primary care research, the Health Care Financing Administration, and the National Center for Health Statistics will probably be needed. Extensive consultation with data experts, health care plans, professional groups, the states, and the primary care research community would be in order in developing these standards. Implementation of the planning and design phase could begin immediately.
The federal agency supporting primary care research and the foundations would need to take responsibility for the design and implementation of the study proposed in Recommendation 8.5. Consultation with appropriate physician groups would be essential. Implementation of the study design and consultation phase could begin immediately.
With the apparent demise of comprehensive health care reform, the climate for moving ahead on a reform agenda affecting primary care might seem to be unfavorable. Yet, as noted at the beginning of this report, the pace of change in the health care systems of communities around the country remains very rapid. In those changes and the restructuring being proposed for Medicare and Medicaid, opportunities exist to pursue a strategy that holds promise for making the American health care system more effective and efficient. Important parts of the primary care agenda and strategy for implementation proposed in this report do require federal actions. For many elements, however, the key decisionmakers are more diffusely located across the states and communities of the nation, health care plans, educational institutions, and professions. The great private foundations, are also well suited to undertake some parts of this agenda and to engage in collaborative efforts with the other interested parties.
Many of these groups are already committed to a renewed emphasis on primary care. In this situation, opportunities for coalition building and for implementation are at hand and should be exploited. That fact alone is one important reason that the committee has recommended establishment of the primary care consortium.