New Report Reveals Lack of Support for High-Quality Primary Care in US

March 9, 2023

A recently released report finds a chronic lack of adequate support for the implementation of high-quality primary care across the United States. 

The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care, funded by the Milbank Memorial Fund and The Physicians Foundation, offers baseline trend data for the nation and, when available, for states across four key dimensions: financing, access, workforce development, and research.  

Developed in collaboration with researchers at the American Academy of Family Physicians’ Robert Graham Center, the scorecard provides a measurement tool to track the health of primary care nationwide to inform federal and state policies. 

This inaugural scorecard was developed in response to the challenge issued in the National Academies of Sciences, Engineering, and Medicine (NASEM) 2021 report calling for an annual tracking tool to measure improvements in the implementation of high-quality primary care over time. 

The scorecard measures key primary care indicators over the past decade and reveals the need for policies to improve a primary care infrastructure in crisis. 

Scorecard findings — available in the report and a companion online dashboard — reveal: 

Financing: Systemic Underinvestment in Primary Care 

• The U.S. invested less than 6.5% of total health spending on primary care between 2010 and 2020. By comparison, Organization for Economic Co-operation Development (OECD) nations spent an average of 7.8% of total healthcare expenditures on primary care in 2016, according to the NASEM report. 

• Medicare spent the least on primary care as a percentage of total health spending, and spending in Medicaid has fallen nearly continuously since 2014, from a high of 5.3% to a low of 4.2% in 2020. 

• Oregon had the highest primary care spending, at 9.6% of total spending, of the 29 states with data in 2020. 

Access: Primary Care Physician Workforce Shrinking and Gaps in Access to Care Appear to Be Growing 

• One in three physicians practiced primary care in 2010, yet only one in five medical residents (20% to 21%) entered primary care between 2012 and 2020. 

• Between 2012 and 2020, the gap in the number of primary care physicians per 100,000 people in medically underserved areas (MUAs) and non-medically underserved areas increased by 5%. 

• More than a quarter (27%) of U.S. adults reported that they didn’t have a usual source of primary care or used the ER as their source of care in 2020, compared with 23% in 2010. 

Workforce Development: Too Few Physicians Being Trained in Community Settings 

• There are significant discrepancies between where physicians are trained and where people live and work. 

• In some states, only 5.9% of resident physicians are trained in MUAs or rural counties, where most community-based training occurs. 

Research: Almost No Federal Funding for Primary Care Research 

• From 2017 to 2021, the percentage of National Institutes of Health dollars allocated to family medicine departments remained stagnant at just above 0.2% a year. 

The report authors also found that a lack of timely, disaggregated data hinders the accurate measurement and implementation of high-quality primary care at the national and state levels. For example, current data cannot provide a complete and accurate picture of the supply and training of all members of the primary care workforce (not just physicians), the percentage of primary care payment that is hybrid, or the impact of information technology on the patient and the provider. 

The NASEM report identified recommendations for public and private stakeholders related to each of the key primary care indicators highlighted in the scorecard to strengthen support for primary care. To reform payment, for example, NASEM suggests the Centers for Medicare & Medicaid Services and states increase the overall portion of spending going to primary care. Additionally, to improve access, the U.S. Department of Health and Human Services should target sustained investment in creating new health centers in areas with a shortage of primary care.