“The visit drop was larger in poorer areas, just as out-of-pocket costs for most primary care provider visits went up,” Ganguli said.
It’s also possible some people simply went elsewhere for services. Visits to what researchers described as “alternative settings” climbed 47% during the study.
“Americans are using urgent care centers, retail clinics and emergency departments more—though these rates are still very low relative to primary care visits,” Dr. Ganguli says.
The study wasn’t designed to determine whether or how changes in availability or affordability of care or other factors might directly affect how often people visit primary care providers.
Results from people with private health insurance may not represent what would happen for people with government coverage, such as Medicare or Medicaid, or for the uninsured.
Even so, the results suggest that many people don’t recognize the importance of regular checkups, said Kimberly Rask, MD, PhD, a professor of health policy and management at Emory University, Atlanta, and author of an editorial accompanying the study.2
“There is very strong evidence that primary care can improve health outcomes through timely screening for preventable diseases and effective management of chronic conditions like high blood pressure and diabetes,” Dr. Rask says by email. “If people are avoiding ‘well-care’ or disease management visits because of the co-pays, then they may be at risk of poor health outcomes and higher costs for both them and the healthcare system in the future.”
References
- Ganguli I, Shi Z, Orav EJ, et al. Declining use of primary care among commercially insured adults in the United States, 2008–2016. Ann Intern Med. 2020 Feb 4.; [Epub ahead of print 4 February 2020].
- Rask K. Pricing patients out of primary care. Ann Intern Med. 2020 Feb 4. [Epub ahead of print 4 February 2020].
