To the Editor:

I applaud Dr. Marc Rivo's “systems approach” to primary care (“It's Time to Start Practicing Population-Based Health Care,” June 1998). Doing the same thing the same way for each person with each condition in a practice, and then studying our practices to ensure consistency and completeness in our approach, is the only way practices can have an impact on the incidence and prevalence of disease among our patients.

One technical point: population-based primary care is the system of health care services distribution that includes every person in a primary care practice located within a geographical area. And it creates incentives for every participating primary care practice to take responsibility for the health of every person assigned to it as well as all the other people in that area.

Population-based primary care represents a health care services distribution system that encompasses the ideals of family medicine: the universal availability of health care that is relationship-focused, community-based and lifelong. And it includes all the critical elements of a rational health care system: affordability, accessibility, fair distribution, respect for patient's autonomy and effectiveness in controlling the incidence and prevalence of disease.

Dr. Rivo describes the advantages of a practice-based systems approach. But I am thrilled any time we have the chance to discuss the advantages of population-based primary care, which is the horse family medicine should be riding in the race for rational health care reform.

Editor's note:

Do you think population-based health care is an appropriate model for family practice? Could the “systems approach” to population-based primary care be adapted to your practice? Have you implemented this approach to improve the care of your patients? FPM is interested in your experiences with population-based health care. E-mail us. We'll publish selected comments in an upcoming issue.