About 40% of US population spent $0 on primary care in 2019, study finds

Key takeaways:

• On average, primary care spending was $439 per person in 2019.
• The percentage of health care spending on primary care was 7% overall but lower for those in worse health.

More than 40% of the United States population did not have any primary care spending in 2019, a study in JAMA Internal Medicine found. This percentage was even higher for Hispanic, non-Hispanic Black and uninsured individuals, data show.

According to Sandra L. Decker, PhD, and Samuel H. Zuvekas, PhD, both from the Agency for Healthcare Research and Quality, previous primary care spending reports focused on the Medicare fee-for-service population and in small samples of commercially insured populations.

“In this survey study, we assessed primary care spending in the entire U.S. community population regardless of insurance source,” they wrote.

The researchers analyzed 2019 primary care spending estimates using the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of individuals, employers and medical providers.

The analysis included 28,512 MEPS participants with a mean age of 38 years, 51.1% of whom were women and 59.7% were non-Hispanic white individuals.

Overall, Decker and Zuvekas found that primary care spending in 2019 was about $439 per person and was highest for the Medicare population ($736) and lowest for the uninsured population ($78). Those with private insurance groups spent about $461.

The percentage of medical spending on primary care was:

• 7% for the entire population;
• 5.1% for those aged 65 years and older;
• 5.6% for those in worse health; and
• 5.3% for Medicare beneficiaries.

Almost 41% of the U.S. population spent $0 on primary care, according to Decker and Zuvekas. That percentage, they added, was substantially higher for Hispanic individuals (52.7%), non-Hispanic Black individuals (49%), non-Hispanic other individuals (44.3%) and uninsured individuals (79.9%).

The researchers acknowledged that MEPS is susceptible to underreporting of medical visits; however, “the degree of underreporting varies little by population characteristics: age, sex, race and ethnicity, and insurance source.”

The findings come as experts raise concerns over the lack of investment in primary care in the U.S., particularly when compared with other high-income countries. In Denmark, for example, about 21% of health care investments go into primary care, experts said at the Primary Care Collaborative annual meeting.

According to Decker and Zuvekas, “several states have established targets for insurers’ shares of primary care spending under the assumption that higher shares are better.”

“Because this share varies by characteristic, adjusting targets for some characteristics, such as age, may be needed, although having different targets for other characteristics, such as race and ethnicity, is problematic,” they wrote. “Consensus on the ideal share of medical spending on primary care may be difficult to reach, but the large fraction of the population with no primary care spending, especially among uninsured individuals, seems likely to be suboptimal.”

References:

• Decker L, Zuvekas S. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.1551.
• First national primary care scorecard reveals a health care sector in peril. https://www.milbank.org/news/first-national-primary-care-scorecard-reveals-a-health-care-sector-in-peril/. Published Feb. 22, 2023. Accessed June 6, 2023.