A downward trend in primary care visits among insured U.S. adults can't be traced to just one cause, according to a study published Feb. 4 in Annals of Internal Medicine, but the AAFP pointed to the report recently to highlight the fact that cost of care is one factor.
Authors of "Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016"(annals.org) said the drop -- 24.2% over nine years -- appears to be related to several factors.
Researchers examined claims data from 2008 through 2016 for patients ages 18 to 64 enrolled with a nationwide commercial health insurer, looking at utilization patterns, visit types (i.e., problem-based vs. preventive), differences among patients and geographic areas, out-of-pocket costs, and visits to specialists and alternative care venues.
They found that the number of primary care visits per 100 member-years dropped from 169.5 to 134.3 during the study period, and the proportion of adults with no primary care visits in a given year rose from 38.1% to 46.4%.
This decrease was greatest among those
- living in areas where the median household income is no higher than twice the federal poverty level (down 31.4%),
- ages 18 to 34 (down 27.6%),
- living in metropolitan areas (down 26.8%) and
- with no chronic conditions (down 26.4%).
The authors also found that during the study period, out-of-pocket cost per problem-based visit rose by 31.5%, and visits to nonprimary care venues increased by 46.9%.
According to the authors, an understanding of how adults with commercial insurance receive health care may help shape health care policy and changes in how health care is delivered "to sustain the benefits of primary care."
"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," they wrote.
Specifically, they suggested that the way patients receive care appears to be influenced by increasing financial and geographic barriers to primary care access, as well as by the availability of telemedicine, online medical information and venues such as urgent care clinics.
The Academy emphasized those financial barriers -- and the harms to which they lead -- when citing the report in its response to President Donald Trump's State of the Union address earlier this month.
"We continue to see the devastating effects of delaying or declining prescribed medications and needed treatments because patients can't afford them," said the statement by AAFP President Gary LeRoy, M.D., of Dayton, Ohio.
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