Prioritising primary care in the USA

Although the USA spends more on health care despite having worse outcomes than other high-income nations, one area where it underinvests is primary care. Research has shown that higher levels of spending on primary care lead to improved patient outcomes and lower overall health-care costs. On July 17, 2019, the Patient-Centered Primary Care Collaborative (PCPCC) issued the first report to look at primary care spending by state, including spending from across different types of payers: commercial insurance companies, government-provided insurance (Medicare and Medicaid), as well as the uninsured. Because of the limitations of survey data originally designed to estimate national and not state-level usage, their report compares primary care spending in the 29 largest states, representing 88% of the US population.

One of the persistent problems with looking at primary care spending is that the definition of primary care remains vague. The PCPCC analysis defined primary care using two standards: narrow and broad. The narrow definition of primary care included expected categories like general practitioners, internal medicine, and paediatrics, whereas the broad analysis expanded that definition of primary care to include obstetrics and gynaecology, visits with nurse practitioners and physicians' assistants, and behavioural health services (including mental health services like psychiatrists and psychologists, as well as social workers).