Declining to invest in primary care has caused Americans’ average life expectancy to stagnate or decline, a new report shows. Published on Feb. 28, “The Health of U.S. Primary Care: 2024 Scorecard Report — No One Can See You Now” also demonstrates that the failure to put more funding into primary care has led to health disparities in both primary and preventive care.
Those six words, “No one can see you now,” can mean a delay of weeks or longer for patients of all ages seeking to book an appointment with a primary care physician or pediatrician. Such delays cause conditions to worsen and costs to rise, the report revealed.
The 2024 scorecard on the U.S. primary care system is the second one that three organizations (the Milbank Memorial Fund, The Physicians Foundation and the American Academy of Family Physicians’ Robert Graham Center) have published since 2021.
Both the latest and the first scorecard came in response to a 2021 report from the National Academies of Sciences, Engineering, and Medicine (NASEM).
That report was a call to action for federal and state governments, health care organizations, health insurers and other payers to strengthen the nation’s primary care system. This would be accomplished primarily with more funding to train primary care clinicians, including doctors, internists, internal medicine specialists, family physicians, obstetricians and gynecologists, and pediatricians.
These doctors work closely with physician assistants (PAs), nurse practitioners (NPs) and nurse midwives, all of whom deliver primary care under the physicians’ supervision.
Covering primary care in the states
For health care journalists, the latest scorecard could be a roadmap to cover primary care in every state, said Yalda Jabbarpour, M.D., lead author of the study and director of the Robert Graham Center for Policy Studies. As a practicing family physician, Jabbarpour sees patients at MedStar Georgetown University Hospitals in Washington, D.C.
On March 12, Felice J. Freyer, who covers health care for The Boston Globe, used interviews with a patient, two primary care physicians and a pediatrician to explain the issue thoroughly. One of the PCPs, Vicki Noble, M.D., told Freyer she left private practice to work at a Veterans Administration clinic to avoid the administrative tasks health insurers require and the data entry needed for electronic medical records, two issues the Milbank scorecard highlighted.
The scorecard itself presents national averages and other national-level data showing funding, access, training and research data in each state.
“What the states do varies, because some states are doing things right, and other states are far behind the national benchmarks,” Jabbarpour said in an interview.
Data from 2021 show, for example, that the two top-performing states on key measures reported in the scorecard were Idaho and Alaska. Those two states ranked first and second, respectively, in terms of having the highest percentage of the physician workforce in primary care, the latest scorecard showed.
In Idaho, 38.2% of clinicians worked in primary care, compared with 28.6% nationally, the report noted. Alaska ranked second at 36.2%, and first for having the most primary care clinicians (meaning physicians, PAs and NPs) working in the most disadvantaged areas.
Social deprivation index
To address the social determinants of health, the Robert Graham Center developed the Social Deprivation Index (SDI) to quantify levels of disadvantage in small areas to evaluate their associations with health outcomes and to address health inequities.
Graham Center researchers worked with other experts to develop the measures built into the SDI and published that research in the journal Health Services Research in a 2013 article.
This measure of social deprivation, in combination with other indicators, has the potential to aid researchers in identifying areas that need additional health care resources, the Graham Center said. For journalists, the latest scorecard shows areas of social deprivation down to the Zip code and block level, Jabbarpour explained.
Other top-performing states include Oregon, which was the highest-ranked state in 2021 for overall primary care spending, putting 7.7% of all health care spending into it, compared with a national average of 4.7%, the report showed.
Oregon also ranked highest in primary care spending among commercial payers (9.1%) and Medicaid (9.2%) compared with national averages of 5.6% and 4.7%, respectively, the report noted. Oregon’s Medicare spending for primary care is slightly lower than that of other payers at 7.3%, but still higher than the national average of 3.9%, the report added.
North Dakota ranked highest among states for new physicians entering primary care (36.4%) annually, better than the national average of 21.6%, the report noted.
North Dakota also has a high rate of physicians, PAs, and NPs who work in primary care at 26.6%, 44.2%, and 39.4%, respectively. These rates are similar or higher than the national averages of 26.6% for PCPs, 29.7% for PAs, and 34% for NPs.
5 reasons for concern
In the report, the three organizations cited five reasons why primary care is inaccessible to many Americans:
- The primary care workforce is not growing fast enough to meet the population’s needs.
- The number of trainees who enter and stay on the professional pathway to primary care is too low, and too few of those residents have community-based training.
- The U.S. continues to underinvest in primary care.
- Technology (meaning electronic health record systems) is a burden in primary care.
- Research is lacking to identify, implement, and track novel care delivery and payment models.
Without more funding, the nation’s primary care systems remain weak and under-resourced, despite the fact that primary care physicians account for 35% of all health care visits, the 2021 NASEM report showed. Despite this high visit rate, primary care providers got only about 5% of health care expenditures, the 2021 report revealed.
“Moreover, the foundation is crumbling: visits to primary care clinicians are declining, and the workforce pipeline is shrinking, with clinicians opting to specialize in more lucrative health care fields,” reads the report.
When patients lack access to high-quality primary care, minor health problems can become chronic diseases, care management becomes more difficult and less coordinated, visits to emergency departments rise, preventive care lags, and health care costs rise to unsustainable levels, NASEM noted.
“People in countries and health systems with high-quality primary care enjoy better health outcomes and more health equity,” reads a press release for the 2021 report.
Editor’s note: This article was updated on March 18, 2024 to include the name of the Feb. 28 report.
