SOCIAL and economic changes demand a sweeping revolution of the existing health care system which has numerous shortcomings, according to the WHO Report, 2008. These failings include: inverse care where the poor use the least health care, compared to those with the most resources; weakening care where 100 million people become poor because they have to pay large sums of money for health care; uneven and unreliable care, whereby care for the poor is patchy and significantly under-funded; unsafe care, whereby poor safety and poor hygiene standards result in hospital-acquired infections; and misdirected care, whereby resources focus mainly on curative services, and so overlook the capability of primary prevention to prevent 70 per cent of the disease burden.

A Primary Health Care (PHC) system would prevent many of these weaknesses; and PAHO/WHO concluded that PHC represents the best-practice method for creating sustained and equitable health improvement for everyone.
PAHO/WHO presents a PHC-based health system as a system that: (1) Is holistic; (2) offers the person the right to maximise his/her health; (3) helps a person to reap the benefits of equity and solidarity; and (4) implements the principles of receptiveness to people’s health needs, quality orientation, governmental responsibility, social justice, sustainability, participation, and intersectorality.
Evidence on the effectiveness and efficiency of primary health care is its capacity to prevent ill health and death (Starfield and Macinko, 2005). The point to note is that there is need for better health outcomes and improved health care at least cost.
For instance, primary care brings reduced hospitalisation among children in U.S. communities with sizeable numbers of primary care physicians. Primary care advances better health equity and better health outcomes, and lacks waste. Prevention is quite effective in primary care. For instance, those States in the U.S. with a higher ratio of primary-care physicians to populations have reduced smoking rates, have less obesity, and apply greater seat belt usage than those with a less ratio of primary-care physicians to populations.
And Donaldson, Yordy, and Vanselow (1996) at the Institute of Medicine noted the value of primary care as a setting where patients present comprehensive problems, and can have a reasonable expectation that these problems will be addressed without referral; where the primary care practice directs patients through a multifaceted health system in relation to referrals from other settings; where it promotes a healthy patient/clinician relationship, and enables the patient to input decisions on his/her own care; and where it sets itself up as a conduit between the health system and patients, their families, and the general community.
Starfield and others noted that primary health care needs governmental commitment to increase population-responsive primary care services; and indicated that primary care would be effective if its four features happen: (1) where there is first-contact access for every new health need and the population uses the services as needed; (2) where there is longitudinality, that is, long-standing person-focused health care where there is some consensus between patients and provider of their shared association, and that the patients will use the service over a long period of time; (3) where there is comprehensiveness, that is, where the provider provides wide-ranging care for nearly all health needs; and where there is coordination involving an information system supplying adequate information to meet patient-care needs.
Starfield in a presentation at the University of Sao Paulo, Brazil in 2006, argued that primary care-oriented countries would have reduced low birth weight, reduced infant mortality rates, greater life expectancy, and reduced years of life lost arising from ‘all except external’ causes.
In 2008, about 240,000 primary care physicians constituted 35% of the medical profession (Phillips and Bazemore, 2010). Arvantes (2010) noted that by 2008, primary care physicians had to deal with 568 million patient visits, amounting to around 57% of total patient visits in the U.S.; and that notwithstanding this huge involvement of the primary- care physician in responding to a large number of patients, the U.S. Administration only allocates 6-7% of total national health care expenditure for Medicare patients. And primary care obtains less public funding than specialisms when compared to other advanced countries (Cameron, 2010). And on life expectancy and under-5 mortality rate, The United States lags behind Canada, The United Kingdom, Germany, France, Switzerland, Sweden, Austria, and Japan.

Source: The World Bank Group 2011.

With all of this happening, it is not surprising that Bodenheimer (2003) reported that primary care physicians are hackneyed and discontented, and medical students are showing little interest in the primary-care discipline.
If it is so well established that primary care delivers better care at reduced cost, then why is the U.S. lagging behind advanced nations on important health indicators? The answer is that primary care in the U.S. is in crisis.
The U.S. had a primary care score of 10, signifying poor primary-care performance, notwithstanding its high per capita health-care spending. Goodson (2010) explained that President Barack Obama’s Patient Protection and Affordable Care Act of 2010 is expected to revive the ailing primary care system in the U.S. Some provisions include even out and increase the primary- care physician workforce; an immediate 10% increase in physician payment; adjust the off-centre, resource-based relative value scale, and promote innovations in primary health care.
Bodenheimer and Pham (2010) indicated that in 2005, 300,000 physicians and 100,000 nurse practitioners and physician assistants offered primary health care in the U.S. Nonetheless, primary care was not attractive to a large number of medical graduates, as many of them opted for sub-specialties. These researchers noted that 65 million Americans lived in officially designated primary health care areas with a shortage of primary health care practitioners; and where adults do not receive timely health care.
And there is overwhelming evidence from Starfield, Shi, and Macinko (2005) that the U.S. needs comprehensive primary health care to transform its poor health indicators and obtain better value for its massive per capita health spending. Obama moved in this direction to bring into the health-care system 30 million of over 40 million Americans without health care vis-à-vis the Patient Protection and Affordable Care Act of 2010. Countries with many of their poor experiencing fragmented and unreliable health care should contemplate devising and/or improving their primary health care.