Between 2008 and 2016, the number of annual primary care visits for every 100 people with private health insurance declined by 22%, from 169.5 to 134.3, the study found. Over that same period, the proportion of adults who didn’t see primary care providers at all rose from 38% to 46%.
“We know that primary care has lots of benefits,” says lead study author Ishani Ganguli, MD, PhD, of Harvard Medical School and Brigham and Women’s Hospital, Boston.
“So it’s still really important to have a primary care provider if you can get one—someone you trust, who knows you as a whole person, is the first call [or email] you make when you have a medical issue, and helps you coordinate your care with specialists,” Dr. Ganguli says by email.
Primary care has long been recognized as a key to improving health outcomes and curbing runaway growth in medical costs in the U.S., researchers note in the Annals of Internal Medicine.1 Although previous research has documented a decline in primary care visits, earlier studies haven’t offered a clear picture of why adults with private insurance—who may not have financial barriers to care—still may skip these visits.
For the current study, researchers examined insurance claims data from a commercial insurer with enrollees in all 50 states that typically covers about 20 million members each year. The analysis included adults age 18 to 64 who had at least one month of coverage in a year.
The steepest decline in primary care visits was, perhaps not surprisingly, among the youngest, healthiest individuals. The proportion of adults age 18 to 34 without any primary care visits in a year rose from 48% to 57% during the study.
Among the oldest people in the study, age 55 to 64, the proportion without primary care visits climbed from 27% to 34%.
Sick visits also became less common over the study period, with the average number of problem-based visits dropping from 154.5 for every 100 enrollees to 112.8. Visits for minor complaints also declined, from an average of 33.4 yearly visits per 100 members to 18.1.
Preventive checkups increased by 41% from an average of 15.1 per 100 enrollees each year to 21.5 visits.
Costs may explain some of this. Patients’ average out-of-pocket fees per visit declined 76%, from $20.10 to $4.90, for preventive checkups. But they rose 32%, from $29.70 to $39.10 for problem-based visits.