We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016.
- Authors
Ganguli, Ishani; Shi, Zhuo; Orav, E. John; Rao, Aarti; Ray, Kristin N.; Mehrotra, Ateev
- Abstract
<bold>Background: </bold>Primary care is known to improve outcomes and lower health care costs, prompting recent U.S. policy efforts to expand its role. Nonetheless, there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline.<bold>Objective: </bold>To describe primary care provider (PCP) visit trends among adults enrolled with a large, national, commercial insurer and assess factors underlying a potential decline in PCP visits.<bold>Design: </bold>Descriptive repeated cross-sectional study using 100% deidentified claims data from the insurer, 2008-2016. A 5% claims sample was used for Poisson regression models to quantify visit trends.<bold>Setting: </bold>National, population-based.<bold>Participants: </bold>Adult health plan members aged 18 to 64 years.<bold>Measurements: </bold>PCP visit rates per 100 member-years.<bold>Results: </bold>In total, 142 million primary care visits among 94 million member-years were examined. Visits to PCPs declined by 24.2%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1% to 46.4%. Rates of visits addressing low-acuity conditions decreased by 47.7% (95% CI, -48.1% to -47.3%). The decline was largest among the youngest adults (-27.6% [CI, -28.2% to -27.1%]), those without chronic conditions (-26.4% [CI, -26.7% to -26.1%]), and those living in the lowest-income areas (-31.4% [CI, -31.8% to -30.9%]). Out-of-pocket cost per problem-based visit rose by $9.4 (31.5%). Visit rates to specialists remained stable (-0.08% [CI, -0.56% to 0.40%]), and visits to alternative venues, such as urgent care clinics, increased by 46.9% (CI, 45.8% to 48.1%).<bold>Limitation: </bold>Data were limited to a single commercial insurer and did not capture nonbilled clinician-patient interactions.<bold>Conclusion: </bold>Commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.<bold>Primary Funding Source: </bold>None.
- Subjects
UNITED States; PRIMARY care; MEDICAL care costs; OUTPATIENT medical care; POISSON regression; ADULTS; HEALTH insurance statistics; AGE distribution; CROSS-sectional method; PRIMARY health care; PATIENTS' attitudes; SEX distribution; POISSON distribution
- Publication
Annals of Internal Medicine, 2020, Vol 172, Issue 4, p240
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M19-1834