Primary care spending represents less than 5 percent of total spending among Medicare fee-for-service beneficiaries, according to a new Rand Corp. study published in JAMA Internal Medicine.
For the study, researchers examined outpatient care, hospital services, prescription medications and other medical care received by more than 16 million fee-for-service Medicare beneficiaries in 2015.
The study had a narrow definition for primary care practitioners that included family practice, internal medicine, pediatrics and general practice — as well as a broad definition that included nurse practitioners, physician assistants, geriatric medicine and gynecology.
The study also had a narrow definition for primary care services (office visits and preventive care) and a broader definition (any care provided by a primary care practitioner).
Depending on the definitions used, primary care spending represented 2.12 percent to 4.88 percent of total medical and prescription spending by Medicare Parts A, B and D during 2015, researchers said.
The study found that the share of primary care spending as a proportion of total Medicare fee-for-service spending was lower among Medicare beneficiaries who were older, black, Native American, dually eligible for Medicare and Medicaid, and who had chronic conditions.
Researchers said they also found that the share of primary care spending on a state-by-state basis ranged from 1.59 percent of medical spending in North Dakota to 3.18 percent of medical spending in Hawaii, under the narrow primary care practitioner and service definitions. Under the broader primary care service definition, the range was 2.92 percent in the District of Columbia to 4.74 percent in Iowa.
“There is no consensus about the optimal share of medical spending that should be devoted to primary care,” said Rachel Reid, MD, the study's lead author and a physician scientist at Rand, a nonprofit research organization, concluded. “However, a current estimate of such spending can be a reference point for policy debates about investment in primary care.”
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