Reorganise primary care: patient-centered medical homes in the US

A method of organising primary care surgeries in the form of patient-centered medical homes (PCMH) is currently being actively promoted and given a test-run in the US. The purpose of this model is to resolve the shortcomings of health care for chronic patients in traditional surgeries and restore merit to the material and economic status of primary care doctors. It is mainly based on patients being cared for by a team supervised by the doctor and on the intensive use of new information and communication technologies. This method of organisation is promoted by doctors' associations, health insurers and the public authorities. This is because it is based on a supposedly win-win economic model. Improving health care by primary care medicine is meant to bring about savings on hospitalisation expenses. Although countless pilot schemes are under way, there are no convincing findings to ascertain that PCMHs will generate significant savings. Moreover, the difficulties in turning a conventional surgery into a PCMH should not be underestimated. The way in which doctors are paid in PCMHs is a major subject for consideration. The role of fees for services is questioned. While this payment method is not excluded, it should be rounded off by capitation payments and performance-based payments. By contrast, this detour by the US sheds light on some of the characteristics of the policy implemented in France on healthcare homes. Prat Organ Soins.2011;42(1):27-34