Investing more in primary care could lower health spending — if patients would go along - The Dallas Morning News

The United States spends roughly twice as much on health as other developed countries, over $10,000 per person in 2017. But compared with its peers, the U.S. spends less than half as much on primary care, and maybe that’s the problem.

Primary care can mean different things, but it generally includes visits to a family doctor and an emphasis on preventing disease, managing chronic conditions and coordinating care. Many proponents talk about getting patients to the right care in the right place at the right time because they believe that approach leads to healthier outcomes at a lower price.

“The goal of the health care system should be to promote better health,” said Dr. Christopher Crow, a longtime family physician who started an integrated network to help independent primary care doctors. “If we do that well, it usually lowers the costs.”

Most health care dollars go to treating the sick and unhealthy, usually through fees for each service. Hospitals rack up the biggest share of total health spending, 38%, followed by physicians (including specialists) and prescriptions.

Just under 6% of health spending in the U.S. went to primary care, compared with an average of 14% in developed countries, according to a study released last year from the Primary Care Collaborative.

Crow co-founded the Catalyst Health Network in Plano, which includes 790 primary care providers with over 1 million patients. He wants employers and insurance companies to pay providers for keeping people healthy. He proposes “unbundling” primary care from the usual health coverage and setting a minimum for its share of total spending.

“Doctors and specialists get paid when someone’s unhealthy, and hospitals get paid when bad stuff happens,” Crow said. “We need to start rewarding [providers] for promoting health, stability and coordinated care.”

A handful of states are working to advance primary care with some passing laws to raise the minimum threshold. Rhode Island required health insurers to increase primary care spending by 1 percentage point annually from 2010 to 2014, and it reached 10.7% of health spending. The costs of primary care grew by $27 million, but total medical expenditures declined by $115 million, according to last year’s study.

The report showed that states with a higher share of primary care spending tended to have better outcomes, as measured in emergency room visits, hospital admissions and avoidable hospitalizations.

“Primary care spending is not the silver bullet,” said Christopher Koller, president of the Milbank Memorial Fund, which supported the study “But it’s a way to change the conversation to get people to focus on where the evidence is.”

Texas, which often ranks low in many health metrics, ranks high in primary care spending, which includes physicians in family medicine, internal medicine, general practice, pediatrics and geriatrics. From 2011 to 2016, 6.3% of health dollars in Texas went to primary care, compared with 5.6% for all states.

One reason for the stronger showing is that Texas has more children and teens, and they generally use the most primary care. But many Texans don’t have a so-called medical home.

In a 2018 survey, fewer than half said they went to a doctor’s office when they were sick or needed advice. More than a quarter of respondents said they had no place to go or they went to the emergency room.

Many Texans don’t have health insurance or face high deductibles, and they may not realize that most health insurance plans cover preventive medicine, including an annual checkup.

Primary care has been attracting more doctors, but the number of jobs for specialists grew six times faster from 2005 to 2015, according to the study on primary care. And Texas ranked 45th among the states for primary care physicians per 100,000 people in 2018’s America’s Health Rankings.

Here’s another surprising trend: Visits to primary care providers have been declining and almost half of adults with private insurance didn’t go to the doctor during the year.

That’s among the top findings from a study that included 13 million adults and 250,000 providers. It evaluated 142 million primary care visits from 2008 to 2016, and over the period, visits to primary care providers fell 24%, declining in every age group.

The study, led by Dr. Ishani Ganguli, was published this month in the Annals of Internal Medicine, and she cited three main reasons for the decline.

A growing share of primary care visits were subject to a deductible, especially with the growth of high-deductible health plans. High out-of-pocket costs explain why low-income areas had the biggest drop in visits.

Many patients saw less need for a trip to the office, and younger and healthier people might believe they were better served by emailing the doctor or nurse, she said. More patients also chose to use other venues, including urgent care centers and retail clinics.

Those facilities can be good for one-offs, Ganguli said on Twitter, but they can’t replace a long relationship with a primary care physician.

Crow, who works with so many primary care doctors, said he’s often asked about the prospects for health care, especially in this election year.

“They ask, ‘Do I need to be scared?’” Crow said last week. “I tell ‘em, ‘Absolutely not.’ Everybody wants more primary care. You never hear any politician say we need less of it.”

The question is how to get the rest of the public on board.

Let's block ads! (Why?)

"care" - Google News
February 18, 2020 at 07:01PM
https://ift.tt/2SRQ2SV

Investing more in primary care could lower health spending — if patients would go along - The Dallas Morning News
"care" - Google News
https://ift.tt/2N6arSB
Shoes Man Tutorial
Pos News Update
Meme Update
Korean Entertainment News
Japan News Update

Bagikan Berita Ini