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Last month, I wrote about a study which linked the availability of primary care with life expectancy and which also showed that the availability of primary care providers has a much more powerful impact on life expectancy than the availability of specialists.  Primary care settings are the most cost effective place to offer preventive care, treatment of acute illnesses and minor injuries and management of chronic diseases.  And other studies have shown that spending in primary care results in better outcomes and lower costs.  So it would make sense for society to invest in primary care, right?  Unfortunately a recent Rand study revealed some discouraging information.

  • Only 2% of Medicare spending is on primary care (compared to 7.7% for commercial insurances). Some of this is due to the fact that an aging population requires more expensive specialty and hospital care, but this is still an alarmingly low number.
  • The low was 1.6% in Hawaii and the high was 3.2% in North Dakota.
  • The variations in spending are not related to the availability of primary care and may have more to do with cultural preferences for where a population of people seeks to get their care. Some will have a specialist for each organ system rather than a primary care providers, others appear to be getting basic primary care services in specialist offices.
  • Medicare spending on primary care was especially low for Black Americans (1.7%) and Native Americans (1.5%).

Some states, like Oregon and Rhode Island, have mandated that commercial insurance companies increase their spending in primary care and when that was done it resulted in an overall cost savings of $300 per enrollee per year.  Prior to making those changes costs had been increasing at a rate of $88 per enrollee per year.  The path seems obvious but at this point Medicare has no plans to increase spending in primary care.  Even modest increases would allow primary care practices to expand resources and to compete with hospital systems and specialty practices for recruiting physicians.  And as medical students graduate (often with massive debt), they take note of the fact that primary care specialties are perennially among the lowest paid in our profession.  Additional financial support for this vital service would help to make it a more attractive option for people choosing their career path.  Hopefully Medicare will see the light, and policy makers will work to increase investment in primary care.  It will improve the health of our communities and save money for the healthcare system.

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