When compared with adults in 10 other high-income countries, U.S. adults were the least likely to have a regular place of care or a longstanding relationship with a primary care provider (PCP), according to a recent report from The Commonwealth Fund.
U.S. primary care trails behind other wealthy countries
For the report, researchers evaluated the primary care system in the United States against 10 other high-income countries, including issues such as access to care and the coordination of services. In the analysis, they relied on findings from the Commonwealth Fund's 2019 and 2020 International Health Policy Surveys, as well as the Commonwealth Fund's 2020 International Profiles of Health Care Systems report.
Ultimately, the report found that U.S. adults were the least likely to maintain a longstanding relationship with a regular physician, place of care, or PCP, Fierce Healthcare reports. Overall, however, individuals in countries with better access to primary care were much less likely to delay or neglect care.
"A strong primary care system yields better health outcomes," said Munira Gunja, a co-author and senior researcher at the Commonwealth Fund's International Program in Health Policy Innovations. "Research has shown the importance of primary care in order to help prevent long-term chronic health problems and lower mortality rates."
In addition, the report suggested that individuals in the United States had the least access to home visits and after-hours care. In comparison, the report found that nearly all primary care facilities in Germany, New Zealand, Norway, and the Netherlands offered 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 wrote.
Notably, just half of U.S. PCPs reported sufficient coordination between specialists and hospitals. For example, less than half of U.S. PCPs claimed that they were typically aware when another provider 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, adding that "subsidizing medical education may help incentivize students to go into primary care."
According to the report, U.S. PCPs were the most likely to screen for social service needs. However, U.S. adults were still more likely to worry about having their social needs met when compared with adults in Sweden, Norway, the Netherlands, and Germany.
"Across all the countries," the authors wrote, "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."
According to the authors, the shortcomings of primary care in the United States are the result of decades of underinvestment in primary care. To address these shortcomings, they recommended several steps for policymakers, including decreasing the wage gap between generalist and specialist physicians, investing in telehealth to expand access to primary care, incentivizing providers to improve the continuity of care, acknowledging the importance of social service needs, and facilitating communication between patients' providers.
"Without a solid foundation in primary care, we don't have a solid healthcare system—period," said Commonwealth Fund President David Blumenthal. "Especially now, in the era of Covid-19, the U.S. needs to invest in strengthening our primary care system," he added. (Kreimer, Fierce Healthcare, 3/15; The Commonwealth Fund, Primary Care in High-Income Countries report, 3/15)