PW PODCAST: Primary Care Is Underfunded

In a recent PW podcast, Kevin L. Grumbach, MD, chair of the Department of Family and Community Medicine at
the University of California San Francisco, talked about the challenges faced by primary care physicians today.

We know that primary care is underfunded. We know that historically, primary care is under-resourced. We know that there’s a shortage of medical students going into primary care, and it’s projected to get worse over the next 5 to 10 years.

I always like to tell people that primary care not only treats disease, but prevents disease, and I explain why investing in primary care, both in terms of dollars and human resources, is important. Why is that so critical for improving the health of our population? In a recent study, my colleagues and I were looking at life expectancy trends in the United States.

Prior to the pandemic, we already had a 3-1/2-year shorter life expectancy in the US compared to our G7 counterparts. But we were spending 40% more than the highest net spender on healthcare services. There’s this huge disconnect when we talk about value-based care. We spend way more than other countries on health services, and
yet people die at a much younger age, and there are huge racial and ethnic disparities in the US.

Better Access to Primary Care Tied to Longer Life Expectancy

However, even if you look at non-Latino White people in the US, the average life expectancy for that population is less than the average in wealthy nation counterparts. There are a lot of reasons for that, but almost all those other nations invest a much higher share of their healthcare spending on primary care. We spend about 5 cents on the dollar on primary care in the US. Most other countries spend 10 cents on the dollar or upward. Previous research shows stronger primary care and better access to primary care are associated with longer life expectancy and lower overall healthcare spending.

We observed that, in US counties with an increase in the number of primary care physicians per capita, there was an association with improved life expectancy, compared with counties that lost primary care physicians over a 10-year period.