Barbara Starfield

Barbara Starfield
MD, MPH
USA

Lecture
General Practice as an integrated part of the health care system

Summary of content
A robust literature documents the importance of a strong primary care infrastructure in health systems. The benefits of strong primary care extend from greater effectiveness, greater efficiency (lower costs), and greater equity of health within populations. Strong primary care clinical services depend on supportive health policies in political jurisdictions—and constitute the operational aspect of primary HEALTH care.. Policies that are critical in supporting primary care include distributing resources according to need rather than to market forces, Universal and progressive financing under the control or regulation of the government, no or low cost sharing for primary care, and a broad range of services (comprehensiveness) provided in primary care. The important clinical functions of primary care services are first contact when people have a new need or problem, person (not disease) focused care, a broad range of services available and delivered in primary care (rather than in specialty care (unless the need it too uncommon for the practitioner th maintain expertise), and coordination of care when people must go elsewhere for rare or unusual conditions.
Health systems with excessive specialists suffer high costs, unnecessary care, and higher rates of adverse events.
Although sociodemographic factors undoubtedly influence levels of health, a primary care oriented health system is a highly relevant policy strategy because its effect is clear and relatively rapid, particularly concerning the prevention of the progression of illness and effect of injury, especially at younger ages.

Biography
Barbara Starfield, a physician and health services researcher, is university distinguished professor and professor of health policy and pediatrics at Johns Hopkins University. She is internationally known for her work in primary care; her books, Primary Care: Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology, are widely recognized as the seminal works in the field. She has been instrumental in leading projects to develop important methodological tools, including the Primary Care Assessment Tool, the CHIP tools (to assess adolescent and child health status), and the Johns Hopkins Adjusted Clinical Groups (ACGs) for assessment of diagnosed morbidity burdens reflecting degrees of co-morbidity. She was the co-founder and first president of the International Society for Equity in Health, a scientific organization devoted to furthering knowledge about the determinants of inequity in health and ways to eliminate them. Her work thus focuses on quality of care, health status assessment, primary care evaluation, and equity in health. She is a member of the Institute of Medicine and has been on its governing council, and has been a member of the National Committee on Vital and Health Statistics and many other government and professional committees and groups. She has a BA from Swarthmore College, an MD from the State University of New York, Downstate Medical Center, and an MPH from Johns Hopkins University School of Public Health.