The chapters of this report constitute a road map for reaching the committee's goals, as reflected in five assumptions. First, primary care is the logical foundation of an effective health care system because primary care can address the large majority of the health problems present in the population. Second, primary care is essential to achieving the objectives that together constitute value in health care—quality of care (including achievement of desired health outcomes), patient satisfaction, and efficient use of resources. Third, personal interactions that include trust and partnership between patients and clinicians are central to primary care. Fourth, primary care is an important instrument for achieving stronger emphasis on (a) health promotion and disease prevention and (b) care of the chronically ill, especially among the elderly with multiple problems. Fifth, the trend toward integrated health care systems in a managed care environment will continue and will provide both opportunities and challenges for primary care.
The committee's definition of primary care (see Chapter 2), which the committee formally recommends be adopted (see Box S-1), is presented in terms of the function of primary care, not solely in terms of who provides it. The definition calls attention to several attributes that provide the structure within which the broad themes of this report are addressed. The critical elements include