WASHINGTON, Dec. 2, 2020—The U.S. health system’s investment in primary care, as measured by primary care spending, is low and declined between 2017 and 2019, both nationally and in a majority of states, according to a new report. The Primary Care Collaborative (PCC), a national nonprofit organization working to advance primary care, released the report today, titled Primary Care Spending: High Stakes, Low Investment. The findings support a growing body of literature showing that health systems with a foundation of robust, comprehensive primary care achieve better, more equitable health outcomes and are less costly.

These findings are particularly relevant in the context of COVID-19, which has affected primary care practices financially, with implications for primary care clinicians and their ability to care for patients, including those from marginalized and vulnerable communities.

Key findings of Primary Care Spending: High Stakes, Low Investment:
National spending falls: In 2019 primary care spending across commercial payers was only 4.67% of total national commercial healthcare spending, falling from 4.88% in 2017.
Spending across states varies: The primary care spending percentage across states varied from a low of 3.14% in Kentucky to a high of 9.48% in Michigan in 2019 using a narrow definition of primary care providers and services, and from a low of 5.57% in Pennsylvania to a high of 16.64% in Mississippi using a broad definition of primary care spending. Both the narrow and broad definitions vary by a factor of 3 between the highest- and lowest-spending states.
Spending in most states falling: The negative trend in primary care spending over a three-year period (2017 to 2019) was observed across 39 states when using a narrow definition of primary care clinicians and services and across 30 states when using a broad measure.
Higher spending has health benefits: This year’s report, like PCC’s 2019 report on state-level spending in primary care, documents an association between higher primary care spending at the state level and fewer emergency department visits, hospitalizations, and preventable hospitalizations.
“This study and others have shown that, unfortunately, the U.S. is moving away from primary care, despite the evidence that it is associated with better value, including enhanced population health, greater equity, and more efficient use of healthcare resources,” said Darilyn Moyer, MD, FACP, FRCP, FIDSA, chair of the PCC’s board of directors and Executive Vice President and CEO of the American College of Physicians. “This report highlights to what extent our health system is oriented toward primary care by looking at one of the indicators of it—spending on it."

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