Primary Health Care for the Poor in the United States and Canada

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Abstract
The outflow from the field of primary medical practice has been coupled with the failure of the voluntary insurance system in the United States to pay for the costs of most primary care services. These are facts that are even more applicable to the poor who number between 40 and 50 million persons from the point of view of inability to pay for the skyrocketing costs of health services. In the United States, much primary care for the poor is provided in emergency rooms, charity outpatient clinics, and public health department clinics, and is fragmented between various categorical assistance programs. In contrast, in Canada, primary health care is now a right, whereas it is not in the United States, and so the poor in Canada increasingly obtain their health care within the so–called mainstream system. In the United States a series of new categorical assistance programs have revived the development of the concept of comprehensive, neighborhood–based health centers, but at most 1,500,000 persons obtained care in such centers during 1971. The Meharry Medical College experience in this development is unique and multidimensional. But for the great majority of the poor in the United States, adequate primary health care service and the way to finance it with dignity remains as yet an illusory dream.

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