Policy and Financing in Family Medicine and the Medical Home

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his month we have several articles about policy and financing related to family medicine and the medical home. Setting the stage, Tsai et al1 present the primary care outcomes of the Taiwanese universal health care system, an interesting juxtaposition to health care reform discussions in the United States. Specifically, the authors discuss the negative impact of the unrestricted access to specialists as a usual source of care on the quality of primary care services. Stenger and DeVoe2 follow this and review 59 recent legislative bills (25 of which were enacted) intended to encourage the medical home in the United States; not surprisingly, they note that the definition and mechanisms differ substantially state to state. This sets the stage for a natural experiment to suggest which interventions create better outcomes and can further inform additional health policy changes. Ohman-Strickland et al3 provide indications of the chronic care model features that are associated with improved diabetes care, suggesting those that should be specifically encouraged.