Report: More Americans lack a consistent source of health care

A report from the Primary Care Collaborative (PCC) and the AAFP Robert Graham Center found that more Americans lack a consistent source of health care – most often primary care – despite the pandemic, which does not bode well for Americans’ future overall health.

Differences between racial/ethnic groups in usual source of care (USC) are likely contributors to health disparities, which were made worse by the pandemic.

“Americans with an ongoing primary care relationship dropped 10% between 2000-2019, from 84% to 74%, and ticked up only slightly in 2020,” said Ann Greiner, president and CEO of the PCC, in a statement. “Many innovators are moving into the primary care space because they understand patients are finding it difficult to find affordable primary care. These innovators differ in whether they are supporting longer-term relationships or providing a more transactional set of primary care services.”

Key findings include:

• Hispanic individuals had a 66% higher rate of no USC (34.3%) as compared to their White counterparts (20.7%) in 2019
• Non-Hispanic Black individuals had a 38% higher rate of no USC (28.4%) as compared to their White counterparts (20.7%) in 2019
• There was a 10% decline in USC for those with dual coverage (Medicare & Medicaid) between 2015 – 2020
• 46% of 18–34-year-olds had no USC in 2019, up from 34% in 2014
• In 2020, there was a spread of 27% points in USC across 50 state

“There are structural barriers preventing our children, families, and neighbors from accessing ongoing preventive and comprehensive care when they need it,” said Mark Del Monte, JD, chair of the PCC board of directors and CEO/executive vice president of the American Academy of Pediatrics (AAP), in a statement. “There are opportunities for leaders across government and the private sector to partner with primary care and make investments that will improve physical and mental health and well-being.”

According to the report, financial barriers are an ongoing issue for patients and can interfere with getting regular primary care that helps avoid emergency department visits and addresses health problems early before they worsen.

Asaf Bitton, MD Executive Director, Ariadne Labs - Harvard T.H. Chan School of Public Health noted, “Employers have a very important role to play to ensure that all their employees and their families have ready, convenient access to a usual source of affordable primary care. We applaud those employers who are providing highly accessible virtual and in-person primary care options, and working with preferred provider organizations and health systems to support patients in establishing and maintaining these crucial primary care relationships.”

The PCC Report also highlights the need to attract more diverse students to the primary care workforce so that it better reflects the populations they serve.

“We need to train primary care clinicians in teams in community settings where people work and live as recommended by the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care,” said Yalda Jabbarpour, MD, director of the AAFP Robert Graham Center for Policy Studies, in a statement. “The evidence suggests that residents who train in rural and underserved settings, such as Community Health Centers, are much more likely to end up practicing in such settings. This strategy can help address primary care maldistribution and close USC gaps.”