US lags other nations in access to primary care, coordination with specialists: Commonwealth Fund

The U.S. trails other developed countries in many aspects of its primary care model, particularly in access to and continuity of care, according to a new Commonwealth Fund report.

Only 52% of primary care providers in the U.S., for example, had arrangements for after-hours care, the fourth-lowest total among 10 nations. France, by contrast, had a 91% figure when it came to such arrangements.

The situation is worse when it comes to forming a long-standing relationship with a primary care provider with the U.S. the lowest of all 10 countries surveyed.

Just 43% of U.S. adults reported a regular doctor or place of care relationship lasting at least five years. The highest-performing countries in that category, by contrast, were the Netherlands (76%) and Germany (68%).

“Patients in the U.S. are among the least likely to have access to primary care outside of regular business hours or a longstanding relationship with their primary care physician,” the report said.

Other areas where the U.S. consistently underperforms its peers are in home visits with less than a third of physicians doing so compared with more than two-thirds in all other countries surveyed. And, while screening patients for social needs such as housing and food insecurity was a plus for U.S. primary care providers, there were concerns about coordinating care for patients with the U.S. among the lowest performers in this category along with Sweden, Germany and the Netherlands.

Not just the U.S., but …

While the U.S. underperforms its peers in many aspects of primary care, many of the countries surveyed struggle to ensure access of care, or first contact, the report shared. Continuity of care, comprehensiveness of care and coordination of care are common weaknesses for all the high-income countries studied.

“These four core components of high-quality primary care are essential to better overall health outcomes,” the report said. “Factors like workforce shortages, physician burnout, and dwindling access for patients, driven in part by underinvestment and growing administrative burdens, pose significant barriers to care.”

Such factors are particularly evident in the U.S., however, with the gap between earnings for primary care providers and specialists ever widening while investment in the primary care model dwindles.

In 2021, for example, the U.S. spent just 4.7% of its healthcare budget on primary care compared to an average of 14% in other countries. And, while the earnings gap is the largest among all the developed nations, tuition fees remain the highest.

Federal and state policymakers could therefore enact a series of recommendations, the report said, to improve the primary care model in the U.S. Greater financial support for primary care providers would help boost the comprehensiveness of care. Researchers also recommend investing in the primary care workforce by improving financial incentives such as encouraging doctors to work in underserved areas as well as reducing their loan payments.

Payment for primary care should shift away from volume-based fee-for-service models to population-based payments, the report said. Improving the coordination of the use of electronic health records would facilitate better coordination between primary care providers and other physicians.

Policymakers also need to take steps to reduce the administrative burdens on primary care physicians by taking gradual steps to lessen requirements such as prior authorization and record-keeping. 

The Commonwealth Fund 2022 International Health Policy Survey of Primary Care Physicians was administered to nationally representative samples of practicing primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S.