PCC's New Report Sounds Alarm on Low and Declining U.S. Primary Care Spending

Analysis Suggests Benefits of Strengthening Primary Care as Foundation of Health System

WASHINGTON, Dec. 2, 2020—The U.S. health system’s investment in primary care, as measured by primary care spending, is low and declined between 2017 and 2019, both nationally and in a majority of states, according to a new report. The Primary Care Collaborative (PCC), a national nonprofit organization working to advance primary care, released the report today, titled Primary Care Spending: High Stakes, Low Investment. The findings support a growing body of literature showing that health systems with a foundation of robust, comprehensive primary care achieve better, more equitable health outcomes and are less costly.

These findings are particularly relevant in the context of COVID-19, which has affected primary care practices financially, with implications for primary care clinicians and their ability to care for patients, including those from marginalized and vulnerable communities.

Key findings of Primary Care Spending: High Stakes, Low Investment:

  • National spending falls: In 2019 primary care spending across commercial payers was only 4.67% of total national commercial healthcare spending, falling from 4.88% in 2017.
  • Spending across states varies: The primary care spending percentage across states varied from a low of 3.14% in Kentucky to a high of 9.48% in Michigan in 2019 using a narrow definition of primary care providers and services, and from a low of 5.57% in Pennsylvania to a high of 16.64% in Mississippi using a broad definition of primary care spending. Both the narrow and broad definitions vary by a factor of 3 between the highest- and lowest-spending states.
  • Spending in most states falling: The negative trend in primary care spending over a three-year period (2017 to 2019) was observed across 39 states when using a narrow definition of primary care clinicians and services and across 30 states when using a broad measure.
  • Higher spending has health benefits: This year’s report, like PCC’s 2019 report on state-level spending in primary care, documents an association between higher primary care spending at the state level and fewer emergency department visits, hospitalizations, and preventable hospitalizations.

“This study and others have shown that, unfortunately, the U.S. is moving away from primary care, despite the evidence that it is associated with better value, including enhanced population health, greater equity, and more efficient use of healthcare resources,” said Darilyn Moyer, MD, FACP, FRCP, FIDSA, chair of the PCC’s board of directors and Executive Vice President and CEO of the American College of Physicians. “This report highlights to what extent our health system is oriented toward primary care by looking at one of the indicators of it—spending on it."

“This report is a three-alarm fire,” said Ann Greiner, PCC’s President and CEO. “The primary care platform was shrinking—and then the pandemic hit. Primary care practices were slammed financially and did their best to respond to patients’ needs, but they have been hamstrung. Patients, particularly those in vulnerable and marginalized communities, are the collateral damage.”

The report is the second consecutive year that the PCC has reported primary care spending nationally and at the state level. The report also confirms an association between higher primary care spending at the state level and fewer emergency department visits, hospitalizations, and preventable hospitalizations, documented in the PCC’s 2019 research report.

A section of the report provides updates on state governments’ actions toward increasing their investments in primary care in 2019 and 2020. To date, 12 states have reported or committed to report primary care spending, and some states are setting spending targets for primary care, according to the report.

To develop the report, the PCC used data from FAIR Health on healthcare claims for persons of all ages enrolled in private insurance plans (both fully insured and self-insured), including employer-sponsored, individual and Medicare Advantage plans, in all 50 states. The PCC uses the definition of primary care spending of the percentage of total annual spending on medical care services and prescription drugs that is spent on primary care services. And generally accepted narrow and broad definitions of primary care clinicians and services—what they encompass—are used in the report.

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Learn more:

These experts are available for interviews about the report:

  • Darilyn Moyer, MD, FACP, FRCP, FIDSA, chair of the PCC’s board of directors and Executive Vice President and CEO of the American College of Physicians
  • Ann Greiner, Primary Care Collaborative President and CEO
  • Ann Kempski, Advisor, Primary Care Collaborative

To arrange an interview, contact:

Stephen Padre
Communications Manager, Primary Care Collaborative
[email protected]
202-417-3911

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