Abstract
[This is an excerpt.] Patients in the United States are frustrated with their health care, despite living in a nation with the highest GDP investment in health care in the world. Primary care, when achieving its full potential, has the capacity to enhance life expectancy, improve health outcomes, and lower health care costs.4,5 However, years of neglect and chronic underinvestment by the health care system have left US primary care in a position where it is increasingly unable to meet patients’ needs, particularly in rural and other underserved communities. Today, life expectancy in the United States is lower than in most developed nations that spend much less on health care, and rates of uncontrolled chronic disease are rising.
This combination of worsening primary care access and sicker patients has created a vicious cycle. Patients are driven to use more expensive services like emergency rooms, which raises health care costs and premiums, further reducing affordability and access. At the same time, overall health care spending continues to rise faster than economic indicators, while the crumbling primary care infrastructure receives only a small portion of these dollars.
It is clear that improving the health of patients in the United States depends on repairing primary care. In 2021, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a landmark report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, which presented a comprehensive, evidence-based, and actionable plan to do just that: strengthen primary care. Shortly thereafter, the Health of US Primary Care Scorecard was created to track progress on achieving this goal. In its first year, the Scorecard reported baseline performance on primary care metrics in financing, workforce/access, training, and research and showed that primary care was in peril. In its second year, the Scorecard report, No One Can See You Now, used the same metrics to outline the reasons why access to primary care was deteriorating.
This year, the Scorecard spotlights the downward cycle of financing for primary care, describing how persistent challenges in primary care arise from insufficient investment (or in the case of training, misplaced investment) and a fee-for-service (FFS) payment model that rewards volume rather than continuous, whole-person care. This report highlights how these systemic financial issues not only undermine the effectiveness of primary care delivery but, more importantly, jeopardize the overall health of our communities in the following ways. [To read more, click View Resource.]
