The United States health system is under-investing in primary care, a new report says, leading to higher costs as patients end up hospitalized or in emergency rooms. Not only is there significant variation among states in primary care investment, the United States lags badly behind other developed nations in providing this type of care.

The new report, “Investing in Primary Care: A State-Level Analysis,” was published by the Patient-Centered Primary Care Collaborative's (PCPCC). The results underlined the importance of primary care, which usually includes some sort of “medical home” model, where patients have a primary provider who is familiar with their history and can direct a care team.

The study sought to establish a national average for spending on primary care, and to understand if there are differences across states and payers for this type of care.

The study used two definitions of primary care spending, one narrowly defined to include physicians in outpatient settings, and a second definition that included care from physician assistants, nurse practitioners, and other members of care teams.

Falling behind other countries

The PCPCC study noted that the U.S. spends between 5 percent and 7 percent on primary care as a percentage of total health care spending. This is below the average spending in other developed countries, the researchers said. They noted that Organisation for Economic Co-operation and Development (OECD) countries average 14 percent of health care spending on primary care.

“This under-investment represents a major disconnect given the robust evidence base showing that health systems with a primary care orientation have superior patient outcomes, fewer inequities, and lower costs,” the report said. “On these key attributes, performance of the U.S. health system pales in comparison to systems in other industrialized nations.”

State programs show promise

The PCPCC report said there has been a relatively recent move by the states to increase investment in primary care. The study provides a list of 37 states that have enacted primary care initiatives, with a closer look at 10 states that have promising programs. According to the report, Minnesota had the highest percentage of primary care investment and performed well with respect to patient outcomes. Connecticut had the lowest primary care spend using a narrow definition of primary care spend. New Jersey's primary care spend was lowest with a broad definition.

“This report provides a high-level description of such efforts in 10 states, seven of which initiated their efforts in 2019,” said Ann Greiner, President and CEO, PCPCC. “This activity suggests that there is some momentum at the state level to shift the U.S. delivery system back to its primary care foundation to achieve better patient outcomes, fewer inequities, and lower costs.”

The report noted that the available data isn't sufficient to establish a direct link between more investment in primary care and better care overall. However, even without direct causality, the study said that this research helps to support the idea that more primary care spending leads to fewer emergency room visits and better hospital outcomes.

“The report's finding of an association between primary care investment and reduction of hospitalizations and emergency department visits is in line with existing research on the benefits of robust primary care to a health care system,” said Yalda Jabbarpour, M.D., Medical Director of the Robert Graham Center. “Although this is an important finding we cannot determine causality or directionality of this association.”

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U.S. spending less than other countries on primary care

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