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D. Brad Wright Headshot

Are More Primary Care Docs the Answer?

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A large body of research finds a geographic relationship between the ratio of primary care to specialist physicians and Medicare spending. Specifically, areas with a higher proportion of primary care physicians have, on average, significantly lower Medicare expenditures per capita. Given the concern over the unsustainable growth of health care costs in the U.S., Michael Chernew and colleagues ask an interesting question: Would having more primary care doctors cut health spending growth? You can read their article in the journal Health Affairs (subscription required).

For those without access to the article, here's what they found. There are two health care cost concerns. The first is the absolute level of spending per capita. The second is the rate of growth in those costs. Addressing the first issue, by lowering the amount of spending, shifts the spending curve downward. Addressing the second issue, by slowing the rate of growth, "bends" the curve. Addressing the first issue, but not the second, has the effect of delaying the inevitable. Per capita costs may experience a one-time decrease, but the growth curve hasn't changed, so we'll be right back where we were in a couple of years.

I'll omit most of the details of the research -- I trust most of you don't want to read them anyway -- but I'll give you the results. Essentially, Chernew and colleagues found that increasing the proportion of primary care docs would address the first issue (i.e., it would lead to a one-time decrease in health care spending levels), but would do nothing to address the second issue. What should we take from this finding? Two things. First, having more primary care docs will save us some money now and buy us some more time to reform the system, but it won't fundamentally reduce the rate of health care spending growth. Second, this doesn't mean that we shouldn't increase the proportion of primary care docs for other reasons. Care coordination, preventive medicine, and the like are likely to improve health care quality, as evidenced by research and examples from international settings. The bottom line: There are lots of things that we need to do to make our health care system better, but no single approach is a magic bullet.

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