From the blog Social Change in the New York Times. The article by Tina Rosenberg is here:
America has a serious shortage of primary care physicians, and the deficit is growing. The population is aging — and getting sicker, with chronic disease ever more prevalent. The U.S. will be short some 45,000 primary care physicians by 2020.
The primary care physicians who do exist are badly distributed. There are few that work in rural areas or the poor parts of major cities. In part it’s the money — primary care doctors make less than specialists anywhere, but they take an even larger financial hit to treat the poor.
So without primary care, what happens? When people get sick, they go to the emergency room. Or they wait it out — and then often land in the emergency room anyway, but much sicker.
One solution? Increase the number of nurse practitioner-run clinics -- clinics without doctors. Why? Nurse practitioners provide good healthcare, achieving outcomes equivalent to those found in practitioner-led clinics. Nurses are more "patient-centered" -- a key attribute to successfully treating chronic illnesses where “it’s not about the disease, it’s about the person who has the disease." Additionally, the cost per patient in these clinics is often less. And perhaps most importantly, nurses tend to go where doctors won't.
This should work for developing countries as well. But we have to add incentives so that some of them don't migrate.