U.S. health care a ‘very mixed picture’ with challenges for primary care, staffing

Primary care availability is drying up in some parts of the nation.

Robert Otto Valdez, PhD, MHSA
_{U.S. Agency for Healthcare Research and Quality}

Even so, primary care accounted for more than half of medical physician office visits before the COVID-19 pandemic hit.

The figures are part of the “2022 National Healthcare Quality and Disparities Report” published this fall by the U.S. Agency for Healthcare Research and Quality (AHRQ) under the Department of Health and Human Services.

The report is mandated by Congress to summarized health and health care deliver across the nation. This year’s snapshot is a “very mixed picture,” with highlights of health improvements over time and challenges that need solutions in coming years, said AHRQ Director Robert Otto Valdez, PhD, MHSA.

“As you’ll see, the NHQDR is not prescriptive. Nor does it assign blame,” Valdez said in an online blog post about the report. “Its purpose is to document U.S. healthcare quality and disparities so that everyone — policymakers, health system leaders, researchers, clinicians, and patients — can have a deeper understanding of the challenges we face, as well as the opportunities for making lasting improvements in healthcare delivery.”

Primary care

The report includes data on primary care health professional shortage area (HPSAs), communities with limited or no access to primary care, especially in rural areas. AHRQ cited 2022 data from the U.S. Health Resources and Services Administration (HRSA), which has designated 7,955 locations, population groups, and health care facilities as HPSAs.

It would take at least 16,461 additional practitioners to fulfill the needs of the existing HPSAs, according to the federal estimates.

Across the country, 1,963 of 3,141 counties and county equivalents, or 62.5%, are classified as “whole county” shortage areas. Of those, 562, or 28.6%, are metropolitan counties, and 1,401, or 71.4%, are nonmetropolitan counties.

There are 169 counties, or 5.4%, with no primary care shortage area, with 112 metropolitan counties (66.3%) and 57 rural counties (33.7%). More rural counties have primary HPSAs than metropolitan counties, but more people live in the densely populated metropolitan counties.

High importance

Despite shortages around the country, primary care office visits accounted for 136.6 visits per 100 people – more than half of 860.4 million medical office visits in 2018, the most recent year the figures are available.

By comparison, there were 67.1 visits per 100 people to medical specialists and 63.3 visits per 100 people with surgical specialists, according to the 2018 figures. As for emergency departments, there were 151 million visits, or 46.6 visits per 100 people, according to 2019 figures.

The main reasons for office visits were managing one or more chronic conditions (39%), evaluating new problems (24%), providing preventive care (23%), and performing pre- or post-operative evaluations (8%), the AHRQ report said. The 10 leading principal reasons for visits accounted for 41.6% of all reasons for the office visits.

That “illustrates the wide scope of healthcare services delivered in ambulatory settings,” the report said. “It also highlights primary care offices’ counseling, medication maintenance, and follow-up activities, which are central to successfully managing chronic diseases.”

Help wanted

The health care workforce encompasses a variety of professions, but patients won’t get care if workers are not there. “Staffing shortages may compromise the capacity to care for patients,” the report said.

As of January 2022, the health care workforce totaled an estimated 16.1 million workers, down 2% from January 2020, immediately before the COVID-19 pandemic.

Ambulatory health care workers dropped 16.2% in April 2020, but that sector recovered and had about 8.02 million workers as of January 2022, more than at the start of 2020. Hospitals had about 5.13 million workers, while nursing and residential care facilities had about 2.97 million workers this year, down 2% and 12.1%, respectively, from January 2020 levels.

The good and the bad

AHRQ noted American life expectancy decreased in 2020 due to the COVID-19 pandemic, with a widening life expectancy gap between the United States and other countries since the 1980s.

Efforts to raise awareness and improve health care have worked in some areas. From 2000 to 2020, there were decreases in deaths from breast cancer (-28.7%), colorectal cancer (-37.5%), in-hospital deaths from heart failure (-14.5%), and HIV/AIDS (-57.7%).

But disparities persist by race, ethnicity, household income, and location, while complications from diabetes, and maternal health care, have gotten worse in recent years. The nation also saw 135 rural hospitals close from 2010 to 2020, the AHRQ report said.