United States has work to do to catch up with primary care results in other wealthy nations
Decades of underinvestment and a low provider supply have created significant access issues.
The United States lags behind many high-income nations when it comes to primary care access and continuity.
“Evidence shows that a strong foundation of primary care yields better health outcomes overall; greater equity in health care access and outcomes; and lower per capita health costs,” according to a new report from the Commonwealth Fund. “But in the United States, decades of underinvestment and a low provider supply, among other problems, have limited access to effective primary care.”
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The organization compared the performance of the U.S. primary care system to 10 other high-income countries in four key areas.
Accessibility. Good access to primary care includes the ability to book an appointment with a doctor or regular place of care when care is needed. Research shows that in countries with better access to primary care, patients are less likely to forgo needed care and, as a result, more likely to have better health outcomes. The majority of adults in all 11 countries reported having a regular doctor or place of care, but adults in the United States and Sweden reported this at significantly lower rates.
Care continuity. Patients who have a long-term relationship with their primary care provider are less likely to go to the emergency department. Primary care continuity also is associated with improved care coordination and increased patient satisfaction. Among adults with a regular provider, those in the United States were significantly less likely to report having a longstanding relationship of five years or more with this provider compared to all other countries except Sweden.
Comprehensiveness of care. It is still relatively uncommon for primary care physicians to assess patients’ social needs. Such screenings were most common in the United States and France and least common in the Netherlands and Norway — a difference that, at least for the United States, may be attributable to chronic underinvestment in social services that support healthy living conditions and population health.
Care coordination. Another central feature of primary care is the purposeful coordination of treatment with that provided by other clinicians in different settings. Fewer than half of U.S. primary care physicians reported that they usually are informed when another provider changes their patient’s care plan or medication regimen, and that they usually are informed if their patient is admitted to a hospital or emergency department. That’s about average for the 11 countries studied.
“While there is a shortage of health workers globally, our analysis demonstrates that the U.S. primary care system trails far behind those of other countries in many areas, particularly when it comes to health care access and continuity,” the report concluded. “These findings are consistent with prior research on the challenges facing primary care more broadly and are likely an outcome of chronic underinvestment in primary care in the United States.”
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