Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016
| Autor: | Kristin N. Ray, Ishani Ganguli, E. John Orav, Zhuo Shi, Aarti Rao, Ateev Mehrotra |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Telemedicine Adolescent Cross-sectional study MEDLINE Primary care 01 natural sciences 03 medical and health sciences Adolescent medicine Young Adult 0302 clinical medicine Sex Factors Health care Internal Medicine medicine Outpatient clinic Humans 030212 general & internal medicine Poisson Distribution 0101 mathematics Geriatrics Insurance Health Primary Health Care business.industry 010102 general mathematics Age Factors General Medicine Middle Aged Patient Acceptance of Health Care United States Cross-Sectional Studies Family medicine Female business |
| Zdroj: | Annals of internal medicine. 172(4) |
| ISSN: | 1539-3704 |
| Popis: | Primary care is known to improve outcomes and lower health care costs, prompting recent U.S. policy efforts to expand its role. Nonetheless, there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline.To describe primary care provider (PCP) visit trends among adults enrolled with a large, national, commercial insurer and assess factors underlying a potential decline in PCP visits.Descriptive repeated cross-sectional study using 100% deidentified claims data from the insurer, 2008-2016. A 5% claims sample was used for Poisson regression models to quantify visit trends.National, population-based.Adult health plan members aged 18 to 64 years.PCP visit rates per 100 member-years.In total, 142 million primary care visits among 94 million member-years were examined. Visits to PCPs declined by 24.2%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1% to 46.4%. Rates of visits addressing low-acuity conditions decreased by 47.7% (95% CI, -48.1% to -47.3%). The decline was largest among the youngest adults (-27.6% [CI, -28.2% to -27.1%]), those without chronic conditions (-26.4% [CI, -26.7% to -26.1%]), and those living in the lowest-income areas (-31.4% [CI, -31.8% to -30.9%]). Out-of-pocket cost per problem-based visit rose by $9.4 (31.5%). Visit rates to specialists remained stable (-0.08% [CI, -0.56% to 0.40%]), and visits to alternative venues, such as urgent care clinics, increased by 46.9% (CI, 45.8% to 48.1%).Data were limited to a single commercial insurer and did not capture nonbilled clinician-patient interactions.Commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.None. |
| Databáze: | OpenAIRE |
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