U.S. trails other countries in primary care access

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When it comes to healthcare access and continuity of care, the U.S. trails other developed countries, and, along with Canada and Sweden, has the lowest percentage of respondents saying they have a regular doctor or place to go for care.

The respondents were replying to a Commonwealth Fund report, which found there are growing numbers of U.S. adults without a usual source of care over the past decade. In the U.S. and Canada, younger adults ages 18 to 42 were significantly less likely to have a regular doctor or place of care than adults over age 43.

The data shows why this may be the case: Just 52% of primary care providers in the U.S. had arrangements in place for after-hours care (compared to 91% of providers in France), and just 43% of American adults said they had a relationship with a doctor or healthcare facility that has lasted at least five years (compared to 76% for the Netherlands).

WHAT'S THE IMPACT?

Another area in which the U.S. lags is home visits. Physicians in the U.S. were significantly less likely to report making frequent or occasional home visits than physicians in other surveyed countries, where over two-thirds reported doing so.

These lower rates could be attributed to a smaller supply of physicians overall, but factors like lack of financial incentives, time and training, as well as safety and liability concerns, could also be factors, according to the report. In Germany, where all physicians reported making frequent or occasional home visits, physicians and many specialists are legally required to offer home visits.

Screening for social determinants of health was one area in which the U.S. fared slightly better. About a third of physicians in the U.S. and Germany reported that their practices usually screen or assess patients for at least one social need. In the U.S., there's a push by policymakers and payers to make screening more common and standardized, and according to the authors, this is particularly important given that, compared to other surveyed countries, the U.S. has higher rates of material hardship, such as food insecurity and financial instability, along with a weaker social safety net.

The U.S. is also lagging when it comes to behavioral health. It falls to near the bottom of the pack compared to other countries, although most primary care physicians treat behavioral health issues, and in fact most primary care visits are for behavioral health needs, the report found.

Announced in January 2023, Medicaid programs will now be able to cover interpersonal consultations, in which primary care providers consult with behavioral health specialists to develop treatment plans for their patients. The Centers for Medicare and Medicaid Services also announced a multistate integrated care pilot model where community-based behavioral health providers will form integrated teams of physical health providers and community-based social supports to treat patients.

THE LARGER TREND

To strengthen primary care in the U.S., authors recommend investing more in primary care and growing the primary care workforce. The U.S. has the largest wage gap between generalist and specialist physicians, as well as the highest medical tuition fees among the countries included in the analysis. Policymakers, the report said, can narrow this wage gap and increase federal funding for workforce development by pushing for more competitive compensation and loan repayment programs – particularly those that encourage physicians to practice in rural and underserved areas, such as Teaching Health Center Graduate Medical Education Program and the National Health Services Corps.

Another suggestion is to reform payment for primary care. Moving to population-based payments, which provide upfront, predictable payment, would enable and incentivize physicians to offer a more comprehensive set of services – such as care coordination or addressing social needs – and give them greater flexibility, authors said.

Federal and state policymakers can develop new primary care payment reform models, or scale existing ones, to increase flexibility and hold physicians accountable for patient outcomes, they said.

Other suggestions included facilitating better coordination between primary care and other physicians, and reducing administrative burden on physicians.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.