Underperformance of the healthcare system at great expense is the situation in the United States. The results are great inequity, problems with access, missed opportunities for prevention, fragmented rather than integrated care, relatively poor chronic disease care, and high expenses without commensurate improvements in health as compared with what would be expected from a well-functioning primary care system.1 Indeed, “. . . the need to manage escalating health care costs while maintaining reasonable access to care is becoming the salient challenge in US health care policy”.2
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