From access to care coordination, U.S. primary care lags far behind other wealthy countries: report

Primary care in the United States falls far behind other high-income nations, a new report reveals.

The report, released by the Commonwealth Fund Tuesday, evaluated U.S. performance against 10 other wealthy countries, examining issues such as access to care and coordination of services.

The analysis drew on findings from the Commonwealth Fund’s 2019 and 2020 International Health Policy Surveys, along with the Commonwealth Fund’s 2020 International Profiles of Health Care Systems report.

One of the report’s key findings uncovered that U.S. adults are the least likely to have a regular physician, place of care, or a longstanding relationship with a primary care provider (PCP).

Being able to schedule an appointment with your doctor or regular place of care in times of need is essential. In countries with better access to primary care, patients are less likely to neglect seeking care.

“A strong primary care system yields better health outcomes,” Munira Z. Gunja, a co-author and senior researcher at the Commonwealth Fund’s International Program in Health Policy Innovations told Fierce Healthcare. “Research has shown the importance of primary care in order to help prevent long-term chronic health problems and lower mortality rates.”

The report also indicated that access to home visits or after-hours care is lowest in the U.S. despite evidence that they can strengthen patient-provider relationships. Almost all primary care practices in Germany, New Zealand, Norway and the Netherlands offer both home care visits and after-hours care.

“Making sure primary care is accessible outside standard practice hours can help patients avoid emergency department trips for non-urgent care,” the authors noted in the report.

Only half of U.S. primary care physicians report sufficient coordination with specialists and hospitals. Fewer than half of U.S. primary care physicians reported that they usually know that another provider has modified a patient’s care plan or medication regimen.

“The U.S. has a lot to learn from other countries on the importance of investing in a primary care system that is sufficient and ensuring that they have an adequate supply of primary care physicians,” Gunja said, while suggesting that providing health insurance for everyone would be a great start. In addition, “subsidizing medical education may help incentivize students to go into primary care.”

Meanwhile, U.S. primary care providers are most likely to screen for social service needs. Even so, U.S. adults are also more likely to worry about having their social needs fulfilled, particularly compared to adults in Sweden, Norway, the Netherlands and Germany.

“Across all the countries,” the authors noted, “it is still relatively uncommon for PCPs to assess patients’ social needs, including for housing, food security, transportation and ability to pay for basic needs like utilities, as well as to screen for exposure to domestic violence or feelings of social isolation or loneliness.”

From the authors’ viewpoint, the deficiencies in the United States can be attributed to decades of chronic underinvestment in primary care. They recommended several options for policymakers to contemplate, such as decreasing the wage gap between generalist and specialist physicians, investing in telehealth to broaden access to primary care and rewarding and holding providers accountable for continuity of care.

“Without a solid foundation in primary care, we don’t have a solid healthcare system — period,” Commonwealth Fund President DavidBlumenthal, M.D., said in a statement. “Especially now, in the era of COVID-19, the U.S. needs to invest in strengthening our primary care system.”