Primary care is at the center of vibrant, thriving communities, helping keep families healthy and connected to important resources, children ready to learn, and adults able to pursue education and participate in the workforce.
Primary care is the best way to deliver whole-person care that includes prevention, early diagnosis and treatment, integrated behavioral health screening and treatment, and coordination with other levels of care.
Why Primary Care?
Primary care has not only been shown to reduce overall health care costs but is the only part of the health system that has been proven to lengthen lives and reduce inequities at the population level.
New York State Legislation
Transform New York Communities and Achieve Health Equity By Investing In Primary Care – A.7230-B (Gottfried)/S.6534-C (Rivera)
Primary care saves lives, leads to improved individual and community health, and is unequivocally central to health equity – yet we continue to undervalue and underfund it, and the effects are felt most acutely by marginalized communities. It is time to value the care – and its providers – that has the potential to build a more equitable society for everyone. This bill will help New York move towards a primary care-centered health care system, fostering a patient-centered model of care to ensure that every patient has access to the right care, at the right time, in the right place.
The Impact of Increasing Investment in Primary Care
Increased Access to Primary Care Would Improve Health Equity and Health Outcomes
- Access to primary care is a key social determinant of health.[i] Primary care services, particularly those delivered in community-based[ii] settings, have been proven[iii] to reduce socioeconomic health disparities, but barriers to access, including insufficient coverage or funding, can result in poor utilization of primary care and poor health outcomes.[iv]
- Increased investment in primary care has the potential to improve health equity in a variety of ways, including making care more accessible, increasing the number of providers, and supporting those providers to provide integrated services most needed in underserved communities.[v]
- Regular access to primary care is associated[vi]with positive health outcomes, especially when addressing common chronic conditions such as diabetes, asthma, and heart disease. An increase[vii] of just one primary care physician per 10,000 people can generate 5.5% fewer hospital visits, 11% fewer emergency department visits, and 7% fewer surgeries.
Investment in Primary Care Would Help Address the Shortage of Primary Care Providers
- There is a growing shortage of primary care providers in many communities across the country,[viii] including in New York.[ix] Increased payment to primary care providers for their services can incentivize more clinicians to specialize in primary care and reduce the chance of burnout that results in exits from the workforce.[x]
- An increase in primary care spending could allow providers to bring in more staff and technology to help with administrative tasks so they can spend more facetime with patients and focus on providing the care they were trained for, decreasing burnout and improving patient care.[xi]
Increased Access to Primary Care Would Lower Overall Health Care Costs
Primary care helps prevent, identify, and treat diseases before they become more serious and more difficult to treat – which is more costly to both the patient and the health care system – and difficult to treat. Increasing access to timely, culturally competent, preventive services through primary care is critical to helping New Yorkers attain their highest possible level of health and protecting them from the high costs of advanced disease and emergency care.[xiv]
[i] Office of Disease Prevention and Health Promotion, Access to Primary Care, https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-primary (last visited December 9, 2021).
[ii] Robert M. Politzer, Jean Yoon, Leiyu Shi, et al., Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care 58 Med. Care & Research Rev. 234 (2001).
[iii] Leiyu Shia et al., Primary care, race, and mortality in US states, 61 Soc. Sci. & Med. 65 (2005).
[iv] Office of Disease Prevention and Health Promotion, Access to Primary Care, https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-primary (last visited December 9, 2021).
[v] National Academy of Science, Engineering and Medicine, Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care, Chapter 1, May 2021, available at https://www.nap.edu/read/25983/chapter/3; https://www.nap.edu/read/25983/chapter/1#v
[vi] Leiyu Shi, The Impact of Primary Care: A Focused Review, Scientifica (Cairo), December 31, 2012, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820521/.
[vii] Steven J. Kravet et al., Health Care Utilization and the Proportion of Primary Care Physicians, 121 Am. J. Med. 142 (2007), abstract available at https://www.amjmed.com/article/S0002-9343(07)01088-1/fulltext.
[viii] Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections From 2018 to 2033, June 2020, available at https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf.
[ix] Health Resources and Services Administration, The Health Professional Shortage Area (HPSA) Find Tool, https://data.hrsa.gov/tools/shortage-area/hpsa-find (last visited December 10, 2021).
[x]Rachel Willard-Grace et al., Burnout and Health Care Workforce Turnover, 17 Annals Fam. Med. 36 (2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342603/.
[xi] National Academy of Science, Engineering and Medicine, Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care, May 2021, available at https://www.nap.edu/read/25983 ; Press Release, National Academy of Science, Engineering and Medicine, To Ensure High-Quality Patient Care, the Health Care System Must Address Clinician Burnout Tied to Work and Learning Environments, Administrative Requirements, October 23, 2019, available at https://www.nationalacademies.org/news/2019/10/to-ensure-high-quality-patient-care-the-health-care-system-must-address-clinician-burnout-tied-to-work-and-learning-environments-administrative-requirements
[xii] Primary Care Development Corporation, The intersection of COVID-19 and chronic disease in New York City: underscores the immediate need to strengthen primary care systems to avoid deepening health disparities, Points On Care Series, May 2020, https://www.pcdc.org/wp-content/uploads/Points-on-Care-_-Issue-3-COVID-_-FINAL.pdf.
[xiv] Primary Care Collaborative, Spending for Primary Care, Fact Sheet, 2020, available at https://www.pcpcc.org/sites/default/files/resources/PC%20Spend%20Fact%20Sheet%20.pdf; Alex Kacik, More primary care, more healthcare services, but lower costs in the long run, Modern Healthcare, March 14, 2018, https://www.modernhealthcare.com/article/20180314/TRANSFORMATION03/180319951/more-primary-care-more-healthcare-services-but-lower-costs-in-the-long-run (last visited December 10, 2021).
[xv]U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care Final Report, March 2021, available at https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-finalreport-update-2021.pdf
[xvi] Sonya Streeter et al., The Effect of Community Health Centers on Healthcare Spending & Utilization, Avalere Health, September 2009, available at http://nachc.org/wp-content/uploads/2015/06/CELitReview.pdf.
[xvii] Brad Wright, Andrew J. Potter, & Amal N. Trivedi, Use of Federally Qualified Health Centers and Potentially-Preventable Hospital Utilization among Older Medicare-Medicaid Enrollees, 40 J. Ambul. Care Manage. 139 (2017), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328847/
[xviii] Julia B. Nath, Access to Federally Qualified Health Centers and emergency department use among uninsured and Medicaid-insured adults: California, 2005–2013, available at 26 Acad. Emerg. Med. 129 (2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370496/.
[xix] George Rust et al., Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties, 25 J. Rural Health. 8 (2009), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711875/
[xx] Julia B. Nath, Access to Federally Qualified Health Centers and emergency department use among uninsured and Medicaid-insured adults: California, 2005–2013, available at 26 Acad. Emerg. Med. 129 (2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370496/.
Impact of COVID-19
The COVID-19 pandemic underscored and exacerbated existing health care disparities. People living in historically disinvested and rural communities, people of color, and low-income people had less access to primary care even before the pandemic and experienced both more COVID infections and greater COVID-related mortality and morbidity. Now we are experiencing a secondary public health crisis, a result of deferred and forgone care during the pandemic, as people are coming back to primary care with more severe preventable disease, including more advanced cancers and a drop in childhood vaccinations that could impact children and communities for decades to come. New York State needs to take urgent steps to address the many intersecting public health crises, both those that are a result of COVID-19 and those that predated it, that face the state today.