Share of spending on primary care declines among employer-insured patients
The share of total spending on primary care declined among individuals who were insured through their employers between 2013 and 2017, but this is because total spending on health care grew more quickly, according to data published in JAMA. Researchers explained that primary care may be both a substitute for and complement to nonprimary care services.
“It’s important to further explore this relationship so we understand how efforts to increase primary care utilization and spending will affect other aspects of our health care system,” Julie Reiff, BA, of the Health Care Cost Institute, told Healio Primary Care.
A measure of the value of health care is the share of spending on primary care, researchers noted. A recent study found that primary care accounted for 2% to 5% of total spending among Medicare fee-for-service individuals aged younger than 65 years. Similarly, Reiff and colleagues wanted to look at the share of spending in primary care among individuals aged younger than age 65 years who were insured through their employers from 2013 to 2017.
Reiff and colleagues found that when using a “broad” definition of primary care services — defined as “the share of total spending on services rendered by primary care clinicians” — mean primary care spending increased from $511 among 11,406,520 individuals in 2013 to $538 among 11,608,038 individuals in 2017. However, mean primary care spending declined as a share of total spending from 8.97% to 8.04%. Results also showed that mean total spending increased from $5,701 to $6,688. Children had the highest primary care spending as a share of their total health care spending, with 20.33% in 2013 and 19.54% in 2017, whereas those aged 55 to 64 years had the lowest primary care spending, with 7.25% in 2013 and 6.33% in 2017.
Using a more narrow definition of primary care services — including care planning, evaluation and management visits, vaccinations and other similar services — researchers found that the share of spending on primary care declined from 4.6% to 4.35%. Children, whose share of primary care spending was the only one to change substantially — from 13.68% to 12.51% — were the reason for this decrease, the researchers said. The share of individuals using a primary care clinician increased from 78.35% in 2013 to 79.65% in 2017, and it varied across age groups.
“As a substitute, primary care may decrease spending for specialty and inpatient care, where services are more expensive,” Reiff and colleagues wrote. “As a complement, it may increase utilization of more expensive care because patients are referred to a broader network of clinicians.”
Reiff said that examining data longitudinally to determine whether specialty spending is preceded by primary care spending will shed light on this dynamic.
“We can also look at trends in utilization, such as looking at the number of specialty interactions individuals have, stratified by those with and without interaction with a primary care clinician,” she explained. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.