National scorecard gives low marks to U.S. support for primary care

A new national scorecard aims to be the baseline for future improvement of primary care across the United States – because right now the scores are bad.

The Milbank Memorial Fund, The Physicians Foundation, and the American Academy of Family Physicians’ (AAFP) Robert Graham Center this week published “The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care.” It includes national and state level data across four dimensions: financing, access, workforce development, and research.

Primary care physicians, clinicians, and health care observers hoping for unexpected good news about the specialty will have to look elsewhere.

“We cannot underestimate the critical role primary care plays in our health care system, from improving patient outcomes to enhancing access to quality care for everyone,” Ripley Hollister, MD, said in a news release. A family medicine physician, Hollister is a board member of The Physicians Foundation.

“This first benchmark report provides necessary recommendations to help address the mounting challenges that primary care physicians are facing,” Hollister said. “We look forward to seeing the report published annually to ensure we embrace opportunities to improve primary care and provide a better future for America’s health.”

Getting started

The scorecard and accompanying data dashboard were developed as a response to the 2021 report of the National Academies of Sciences, Engineering, and Medicine (NASEM), which called for an annual tracking tool to benchmark and measure characteristics of American primary care over time.

“Our health care system is wildly out of balance and in critical need of reform,” Milbank Memorial Fund President Christopher Koller said in a news release. “We can do better, and this scorecard can serve as an essential tool for policymakers and other stakeholders to pursue policies that will increase investments in high-quality primary care in every community.”

The NASEM report recommended five objectives for achieving high-quality primary care, so measure in the scorecard are based on those. One – improving health care through information technology that serves the patient, family, and interprofessional care team – has no current data for that category.

Scorecard says

The report summary stated:

NASEM objective: Pay for primary care teams to care for people, not doctors to deliver services.

Scorecard finding: The United States invested less than 6.5% of total health spending on primary care from 2010 to 2020. That is lower than Organization for Economic Cooperation Development nations that spent an average of 7.8% of total health care costs on primary care in 2016. Medicare spends the least on primary care as a percentage of total health spending. Medicaid spending has fallen nearly continuously since 2014.

NASEM objective: Ensure high-quality primary care is available to every individual and family in ever community.

Scorecard finding: The workforce is shrinking and gaps in care are growing. In 2010, one in three physicians practiced primary care, but just one in five, or 20%, of medical residents entered primary care from 2012 to 2020. There are fewer physicians in medically underserved areas and 27.1% of adults reported not having a source of primary care as of 2020, compared to 23.6% in 2010.

NASEM objective: Train primary care teams where people live and work.

Scorecard finding: There are “significant discrepancies” between where physicians train and where people live and work. In some states, just 5.9% of resident physicians are trained in rural counties or medically underserved areas.

NASEM objective: Ensure that high-quality primary care is implemented in the United States.

Scorecard finding: From 2017 to 2021, U.S. National Institutes of Health money allocated for family medicine was stagnant at 0.2% a year.

Sources

The scorecard was developed with researchers at the AAFP Robert Graham Center, based on data from a number of sources. The authors include center director Yalda Jabbarpour, MD, a family physician; Stephen Petterson, PhD, interim research director at the center; Anuhradha Jetty, MPH, senior epidemiologist at the center; and Hoon Byun, DrPH, economist at the center.