Fewer Patients Have Usual Source of Care, Primary Care Provider

There are health disparities in the number of patients with a usual source of care, with some racial groups and publicly insured folks lacking a primary care provider.

The number of Americans with a usual source of care has dropped 10 percent in the last 18 years, with only about three-quarters of people saying they have a regular primary care provider or at least a facility where they know they can access care, according to the Primary Care Collaborative (PCC) and AAFP Graham Center.

The analysis also revealed some health disparities, with folks who are Hispanic, have less than a high school education, are uninsured, and are younger being less likely to have a usual source of care than their counterparts.

PCC defined a usual source of care as either an individual clinician or a facility at which a patient regularly accesses their care. A usual source of care is typically a primary care provider, the organization added, although it can be another type of specialist as well, such as a clinician focusing on a chronic illness.

A usual source of care comes recommended by the National Academies of Science, Engineering, and Medicine (NASEM), the report authors noted.

“This recommendation is grounded in the strong evidence that a USC, particularly a longitudinal one, improves access to healthcare, reduces healthcare costs, increases patient and provider satisfaction, and results in better population health outcomes,” the report authors said.

Not having a usual source of care has documented consequences, including higher likelihood of an emergency department (ED) admission.

But despite the importance of having a usual source of care, the number of Americans who say they have one is dropping. Looking at nearly two decades of data from the Medical Expenditure Panel Survey, the researchers identified a 10 percent decrease in the number of people saying they have a usual source of care.

In 2000, 84 percent of people had a usual source of care, but by 2019 that number shrank to 74 percent. The researchers observed only a slight increase in 2020.

There were some differences depending on how respondents interpreted “usual source of care”—a clinician or a facility. During the study period, the number of people saying a facility was their usual source of care increased by 18 percent; conversely, the number of people naming a person or clinician as their usual source of care decreased by 43 percent.

Moreover, the researchers noted disparities in the number of individuals reporting a usual source of care. Hispanic people and non-Hispanic Black people were 66 and 38 percent more likely to lack a usual source of care than their White counterparts, the researchers said.

Dual-eligible people saw a greater rate of decline in accessing a usual source of care, coming in at a 10-percent drop in just the 2015-2020 timeframe.

Meanwhile, younger patients ages 18 to 34 were less likely to have a usual source of care. In 2019, 46 percent reported having no usual source of care, compared to 34 percent in 2014.

That’s likely because it can be pretty hard to find a usual source of care, the report authors pointed out.

“For millennial patients and younger, there is some evidence that the access and convenience that retail or urgent care settings provide matter more than clinician continuity,” the researchers wrote. “For other patients, especially those who are uninsured or underinsured, the challenge of finding a regular clinician who is taking new patients can be burdensome and may lead to delays in care.”

Cost, in particular, can be a barrier, the report continued, as can the appointment wait times patients face.

Patients do have some resources at their fingertips, the researchers added. As noted above, younger patients are trending toward retail health clinics that may not provide longitudinal healthcare relationships but do offer up convenient care access.

Ann Greiner, president and CEO of the PCC, said these types of entities will be crucial in closing the gap in usual sources of care.

“Many innovators are moving into the primary care space because they understand patients are finding it difficult to find affordable primary care,” Greiner said in a statement. “These innovators differ in whether they are supporting longer-term relationships or providing a more transactional set of primary care services.”

But the task of increasing access to a usual source of care lay beyond the private sector; there is room for policymakers to support the primary care workforce, which could, in turn, increase patient access to primary care providers.

“There are structural barriers preventing our children, families, and neighbors from accessing ongoing preventive and comprehensive care when they need it,” Mark Del Monte, JD, chair of the PCC board of directors and CEO/executive vice president of the American Academy of Pediatrics (AAP), said in a statement. “There are opportunities for leaders across government and the private sector to partner with primary care and make investments that will improve physical and mental health and well-being.”

The report authors recommended reforming how and how much primary care providers get paid to enable better patient access, while changes to health insurance structures could create better incentives for finding and maintaining a usual source of care.

Importantly, ensuring equity in patient access to a usual source of care will require reforms to the medical education process. Particularly, incentives for providers training in underserved areas will increase the odds that providers will practice there for the long haul.

“We need to train primary care clinicians in teams in community settings where people ‘work and live’ as recommended by the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care,” Yalda Jabbarpour, MD, director of the AAFP Robert Graham Center for Policy Studies, noted in the press release.

“The evidence suggests that residents who train in rural and underserved settings, such as Community Health Centers, are much more likely to end up practicing in such settings. This strategy can help address primary care maldistribution and close USC gaps.”

Finally, employers can help make a dent in this area, too.

“Employers have a very important role to play to ensure that all their employees and their families have ready, convenient access to a usual source of affordable primary care,” said Asaf Bitton, MD, the executive director of Ariadne Labs – Harvard T.H. Chan School of Public Health.

“We applaud those employers who are providing highly accessible virtual and in-person primary care options, and working with preferred provider organizations and health systems to support patients in establishing and maintaining these crucial primary care relationships.”

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