Focusing on State‐Level Primary Care Initiatives: From a Small State With a Great Need

摘要

The need for primary care investment has never been greater. Nationally, primary care is in high demand and yet many factors make it difficult to increase the number of practicing primary health care professionals, including salaries, educational debt, and practice redesign. These primary care workforce challenges are particularly acute in Delaware, which is the second‐smallest state by area, the sixth‐smallest by population, the third‐highest in per capita total health expenditures, and the 31st in health outcomes (eg, oral health, infant mortality, obesity rates).1 As a family physician serving as Cabinet Secretary for the Department of Health and Social Services, I faced a challenging fiscal environment my first year in office in which health care costs contributed to a budget shortfall. While state revenues have increased since then, easing the immediate budget pressure, Democratic Governor John Carney, who was elected in 2016, still faces a fiscal landscape in which health care costs consume 30% of the state budget and are growing faster than other components of state spending. Starting in 2017, we had difficult conversations about health care costs and quality, but all of the solutions required a foundation of enhanced primary care and a new direction away from acute and emergent care toward prevention and wellness.2