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Barbara Starfield
MD, MPH, Professor

Find the lecture here

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 problem
  • person and not disease focused care
  • a broad range of services available only in primary care
  • 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.

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 disseminate 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.


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