By NextBestFitShift spending toward primary care
Set a target share of spending for primary care (e.g., 10–12%).
Primary care spending target.
Review ledgerHow this path connects
This path
Shift spending toward primary care
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Set a target share of spending for primary care
- Report primary care spending annually
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Worse outcomes than peer countries despite the highest spending
Directing a target share of spending to primary care supports care whose supply is linked to lower mortality across regions and fewer avoidable hospitalizations.
What it creates or worsens
- Reduces income or business for affected groups
A higher primary care spending share requires money to come from specialists or hospitals.
- Targets and quality metrics invite gaming
Primary care spending targets can be met by relabeling costs.
Who's affected
Who gains
- Low- and middle-income households
- Worse outcomes than peer countries despite the highest spending: Poor health outcomes especially affect low-income and minority communities.
- Black, Hispanic, and Native communities
- Worse outcomes than peer countries despite the highest spending: Poor health outcomes especially affect low-income and minority communities.
- Doctors, nurses, and other clinicians
- Worse outcomes than peer countries despite the highest spending: Directing a target share of spending to primary care supports care whose supply is linked to lower mortality across regions and fewer avoidable hospitalizations.
- Hospitals, clinics, and care organizations
- Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.
Who loses
- Specialist clinicians and practices
- Reduces income or business for affected groups: A higher primary care spending share requires money to come from specialists or hospitals.
- People with ongoing or specialist care needs
- Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.
Other ways to soften the losses
- Phase in
Where it has been tried
- Oregon, Rhode Island: Primary care spending targets.
- Rhode Island, United States: Rhode Island's primary care share of medical spending rose from 5.4% in 2007 to 9.1% in 2012, according to a state-commissioned evaluation.