US government spends more on healthcare than any other industrialized or high-income countries. But the gains from this investment is not proportionally positive. On average, Americans live shorter lives and are more likely to report a cancer diagnosis, cardiovascular disease or other chronic illnesses. One main reason among many is the average American’s ever decreasing access to primary health services.

There is a looming shortage of primary care providers in the country. Experts predict that by the year 2025, the shortage of primary care providers could become a crisis. Even now it is estimated that one in five sick people visit ER for care, they could have accessed from a primary care center.

The percentage of primary care physicians in the US is at 30%, a gradual decline from 50% five decades ago. According to experts the reason for the downwards trend can be traced to the early 40s and 50s when the general public first adopted the idea of advancement in medicine as specialization. As a result, we now have more specialists than ever before but quality of care and access to care took a hit.

Various case studies have related following problems with specialization:

1.Cost of Expertise:

Specialization adds cost to the health system which will ultimately be passed on to patients. Specialists have a greater chance of over-diagnosing a symptom and patients may be prescribed unwanted and costly treatment regimes. Experts are more likely to overuse healthcare infrastructure than a primary care physician. Many scholars now agree that psychological problems like ADHD, depression and some chronic illnesses like chronic kidney disease and some form of cancer are overdiagnosed.

2. Wrong Diagnosis:

Specialists in a field may diagnose a problem through a limited scope, in an attempt to study an issue from such conformity of their respective expertise may lead specialists to conclude the wrong diagnosis. This drawback to properly diagnose a symptom can affect patients with multiple illnesses. When the government is drawing up plans to curb the cost of treating the chronically ill, this diversified islands of thoughts and actions may not be helpful in realizing it.

3. Biases:

Specialists practicing in a field may be biased in diagnosing symptoms or cases outside their area of expertise. Such biases may lead to medical errors such as overlooking the influence of a treatment on other patient conditions, underestimating the seriousness of other health concerns. These biases may be useful in some cases but in most cases usually just adds up cost and endanger the health of patients.

Improving access to estimated 60 million Americans to primary care is not easy but necessary to ensure quality care for all. Various studies reveal primary care and income disparity are the two major influencers in life expectancy and that access to primary care also leads to improved population health parameters. Some of the major benefits of improving access to primary healthcare are below

1. Early Detection

An early detection of disease can help chances of successfully treating these diseases. Early detection is detrimental for effective treatment of some chronic diseases and conditions.

2. Efficiency

In the absence of specialization, a primary care physician will be able to observe and treat symptoms and illnesses in a holistic way making the whole process more efficient. As the whole healthcare policy is tilting away from cost per service to quality of service, the role of primary care professionals will find new importance.

3. Cost-less:

In the prevalent system, a disease is diagnosed after it has occurred. By identifying diseases at an early stage and providing holistic care primary care can cut down the cost of healthcare. Such a system can reduce the number of chronic care cases and thus remove the burden on healthcare infrastructure and also be making it available for more of the population. This will onset a positive cycle, establishing a cost-efficient healthcare system on its own.

The positive influence of primary care access to population health cannot be denied and efforts must be made to refocus attention on primary holistic care. Hope comes in the form of Accountable Care Organization and other initiatives of both federal and state governments compelling healthcare professionals to work together and improve patient outcome. Strengthened primary care may not solve the puzzle that is the US healthcare system, but it sure can be one decisive piece.

Diseases are influenced by various factors that an individual is subjected to, some of which are general factors while others are specific individual factors. While the former is studied in great detail, the latter is not. Understanding individual factors can help us treat disease more effectively or even prevent diseases more altogether.

This method of tailoring treatment to an individual based on specific personalized factors is called Precision Medicine.

Thanks to the rapid advances in the field of genetic mapping, we now understand the influence genes hold on a person’s health and well-being, opening the possibilities for discovering a cure for chronic illnesses like cancer or diabetes. However, the most interesting aspect the concept presents is to cater treatment to patients not on the basis of general understanding of diseases or symptoms, but to the specific need of the patient and critical factors.

The idea of precision medicine is relatively new but holds great promise, and some of the potential advantages of precision medicine are as follows:

1. The efficiency of Care:

Precision medicine makes decisions based on individual specific factors that affect their health. Today, decision making regarding treatments is on the shoulders of the patients, as even doctors do not know how certain treatment will affect a particular individual. With precision, medical providers can cater customized treatment methodology for each of their patients, improving the probability of recovery.

2. Preventive Care:

When the genetic screening process collects enough samples, the results can be used to diagnose genetically caused diseases and even prevent such diseases by understanding the risk of an individual rather than simply reacting to an illness. The presence or absence of some genes can cause diseases, and by studying these variations we can protect ourselves from these diseases.

3. Limit Cost:

Targeted treatment on the basis of genetic mapping can reduce the cost of care with more informed treatment decisions and a greater chance of being effective. The cost will be potentially lower with the focus on preventive care rather than treatment of disease.

4. Population Health:

Studying genetic patterns in a population as a whole, and as sections can help in identifying causes for particular diseases and develop the treatment. Genetic study of sections of a population can predict a likelihood of diseases and early detection.

The advantages listed above make Precision Medicine seem like an attractive investment. These are fields already identified and destined to be addressed by other programs and ideas, but the effect precision medicine can have on healthcare is intense and far-reaching.

But, the skeptics who are not convinced with this plan point out that it has the following drawbacks.

1. Infrastructure Requirements:

Precision medicine has the potential to deeply impact healthcare, but for that, it requires massive infrastructure investments and time to implement. To implement precision medicine, fundamental changes must be made to infrastructure and mechanism of data collection, storage, and sharing. The federal fund earmarked for the development of precision medicine will not cover the requirement and the question of who will have to spend the rest of the fund (state or federal government, providers/patients or payers) is unclear.

2. Legal Problems:

For Precision Medicine to reach peak efficiency, a lot of genomic data must be collected from a large and diverse section of the population. If and when such a massive amount of data is collected, it is legally unclear who owns the data. The government does not own the data and the FDA has blocked individuals from accessing their own genetic information from companies. In addition to legal issues, the collection and storage of such large amounts of data bring privacy into question. As a result, the implementation of such a plan would definitely be met with significant pushback.

3. The relevance of the Information:

According to Former President Obama’s plan, data from 1 million volunteers will be collected for genomic research. The possibility of ‘missing out’ on certain sections of the population or inadequate samples of certain disorders or over-representation of other types of disorder is highly likely.

4. Healthcare Cost:

Ideally, precision medicine can eliminate repeated efforts, readmission and help take preventive measures against disease, stopping the hemorrhage of funds in healthcare. But to reach this stage, it requires massive investment in infrastructure for collecting, storing, and sharing this information.Investment must also be made to security infrastructure to protect the data and other add-on expenses could prove to be a burden.

Precision medicine uses new technologies and techniques to sort and identify the sources for various illnesses to treat, and prevent illness. It holds great hopes but is hampered by the many drawbacks.

The promises it holds are too great for these drawbacks to hold it back for long, and healthcare providers, government and IT professionals should work together to develop a solution to overcome these short-term disadvantages.