Primary Care 101: Supply and Demand

The (ACA) has helped millions of Americans get insured. The hope is that if an individual is insured, he or she is more likely to gain access to primary care. More access to primary care means fewer expensive emergency room visits and hospitalizations.

Source: Matthew Anderson (Flickr/CC)

Source: Matthew Anderson (Flickr/CC)

One fear, however, is that the demand for primary care will skyrocket, but the supply of primary care providers (even with mid-level providers taking on some of the workload) will not be able to meet the demand. Will the ACA decrease ER visits if the newly insured aren’t able to get an appointment with their doctors?

This study examined the relationship between primary care appointment availability and utilization of preventative care services in patients likely to be newly insured by versus .

Interestingly, the authors found that new patient appointment availability for privately insured patients was actually negatively associated with preventative care utilization even when adjusting for provider care density. Instead, it was socio-demographic factors (like the uninsured rate in the county) that were most associated with primary care utilizations. The newly insured often enroll in high-risk, high deductible (so called “catastrophic”) health plans, making it too difficult to afford primary care visits.

Conversely, for patients enrolled in Medicaid, the relationship between appointment availability and preventative care utilization was positive. The difference may result from Medicaid policy, which includes incentives for physicians to offer preventative care to patients and programs that increase the supply of Medicaid-providing physicians in underserved areas.

The QI/QC measures which have been built into Medicaid don’t exist in the private world, so while greater appointment availability for Medicaid patients may indicate a larger number of physicians, the same for privately insured patients may indicate that demand is weaker and physicians are having trouble filling appointment slots.

So what does this mean for policymakers? Perhaps it is time for private insurers to incentivize physicians to provide preventative care and to practice in underserved areas. Maybe we should make insurance plans with more affordable and appealing than the catastrophic plan alternatives.

commentary by Vidya Eswaran

Abstract

Insurance expansions under the Affordable Care Act raise concerns about primary care access in communities with large numbers of newly insured. We linked individual-level, cross-sectional data on adult preventive care utilization from the 2011-2012 Behavioral Risk Factor Surveillance System to novel county-level measures of primary care appointment availability collected from an experimental audit study conducted in 10 states in 2012 to 2013 and other county-level health service and demographic measures. In multivariate regressions, we found higher county-level appointment availability for privately insured adults was associated with significantly lower preventive care utilization among adults likely to have private insurance. Estimates were attenuated after controlling for county-level uninsurance, poverty, and unemployment. By contrast, greater availability of Medicaid appointments was associated with higher, but not statistically significant, preventive care utilization for likely Medicaid enrollees. Our study highlights that the relationship between preventive care utilization and primary care access in small areas likely differs by insurance status. PMID: 25637580.

Saloner, B. et al. Med Care Res Rev. 2015; 72 (2): 149-67.