Why is there a decline in primary care visits?
Access to primary care has been shown to result in more positive healthcare outcomes and reduced costs. One study, conducted by Northwestern Medicine, concluded that “Americans with primary care received significantly more high-value healthcare — such as recommended cancer screenings and flu shots — and reported better patient experience and overall healthcare access, compared to those who don’t have primary care.” However, a separate research effort found that there has been a decline in primary care visits in recent years.
In a study involving the examination of insurance claims from 2008 to 2016 for adult health plan members aged 18 to 64 years, researchers discovered that “commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016.” In fact, visits to primary care physicians declined by 24.2%, while the proportion of adults who had no primary care physician visits in a given year rose from 38.1% to 46.4% over the period studied. 
Primary care is defined by the National Academies of Sciences, Engineering, and Medicine as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The Office of Disease Prevention and Health Promotion (ODPHP) adds that access to primary care is associated with healthier outcomes. So why the decline in primary care visits?
ODPHP explains further that disparities in that access to healthcare definitely exist in the US. Obstacles that patients may face include:
- Lack of health insurance
- Language-related barriers
- Disabilities
- Inability to take time off from work for primary care appointments
- Geographic and transportation barriers, particularly in rural areas
- A shortage of primary care providers, particularly in rural areas
Many of these barriers intersect or overlap for patients who are not able to access primary care services.
A lack of health insurance has been found to decrease the use of preventive and primary care services. The ODPHP states that people who do not have health insurance may put off seeking care when they are ill or injured and are more likely to be hospitalized for chronic conditions, such as diabetes and hypertension, that could be treated by a primary care physician.
Issues with access in rural areas include the distance a patient may have to travel to be able to access primary care services. Rural communities tend to have fewer physicians than do urban areas and the shortage has been growing in recent years. Transportation barriers can keep patients from seeking preventive care such as vaccinations.
The researchers studying health insurance claims also theorize that the decline in primary care visits may be related to “decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care” among patients who would otherwise seek out primary care.
