(Reuters Health)—Almost half of U.S. adults with private health insurance are not visiting primary care providers for routine care or sick visits, a new study suggests.
Between 2008 and 2016, the number of annual primary care visits for every 100 people with private health insurance declined by 22%, from 169.5 to 134.3, the study found. Over that same period, the proportion of adults who didn’t see primary care providers at all rose from 38% to 46%.
“We know that primary care has lots of benefits,” says lead study author Ishani Ganguli, MD, PhD, of Harvard Medical School and Brigham and Women’s Hospital, Boston.
“So it’s still really important to have a primary care provider if you can get one—someone you trust, who knows you as a whole person, is the first call [or email] you make when you have a medical issue, and helps you coordinate your care with specialists,” Dr. Ganguli says by email.
Primary care has long been recognized as a key to improving health outcomes and curbing runaway growth in medical costs in the U.S., researchers note in the Annals of Internal Medicine.1 Although previous research has documented a decline in primary care visits, earlier studies haven’t offered a clear picture of why adults with private insurance—who may not have financial barriers to care—still may skip these visits.
For the current study, researchers examined insurance claims data from a commercial insurer with enrollees in all 50 states that typically covers about 20 million members each year. The analysis included adults age 18 to 64 who had at least one month of coverage in a year.
The steepest decline in primary care visits was, perhaps not surprisingly, among the youngest, healthiest individuals. The proportion of adults age 18 to 34 without any primary care visits in a year rose from 48% to 57% during the study.
Among the oldest people in the study, age 55 to 64, the proportion without primary care visits climbed from 27% to 34%.
Sick visits also became less common over the study period, with the average number of problem-based visits dropping from 154.5 for every 100 enrollees to 112.8. Visits for minor complaints also declined, from an average of 33.4 yearly visits per 100 members to 18.1.
Preventive checkups increased by 41% from an average of 15.1 per 100 enrollees each year to 21.5 visits.
Costs may explain some of this. Patients’ average out-of-pocket fees per visit declined 76%, from $20.10 to $4.90, for preventive checkups. But they rose 32%, from $29.70 to $39.10 for problem-based visits.
“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].
