Rebalancing Health Care Spending

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Primary care is a cornerstone of vibrant, thriving communities and helps keep families healthy, children ready to learn, and adults able to pursue education and participate in the workforce. However, it is estimated that primary care receives a disproportionately small slice of the health care dollar. The national lack of investment in primary care and prevention have led to rising health care costs and mounting rates of chronic illnesses nationally.

An Unbalanced System

Because no national definition of primary care exists, it is difficult to compare primary care outcomes or investment across different states or at the national level. However, it is estimated that as little as 5-7% of U.S. health care costs go toward primary care, with some outliers. An Organization for Economic Co-operation and Development (OECD) analysis of 22 countries estimates that primary care accounts for around 14% of total health spending, about double or triple the estimated national U.S. spend. Due to this insufficient investment, 70 million Americans (1 in every 4 adults) do not have a primary care provider. Evidence shows that an increase of just one primary care provider per 10,000 people can generate 5.5% fewer hospital visits, 11% fewer emergency department visits, and 7% fewer surgeries.

While there is near universal agreement that primary care is critical, funding has not adequately followed. To remedy this situation, to date, seven states have acted to rebalance their health care investments through regulatory or legislative means to define, measure, and increase primary care investment. With a baseline understanding of primary care investment, these states are able to make specific recommendations and requirements towards investment, payment reform, and delivery transformation to improve their primary care systems.

See how states are tackling the issue here.


New York’s underserved communities have a pressing need for primary care, yet the providers and institutions that serve them have been unable to sufficiently sustain, expand, and improve services due to systemic underfunding and undervaluing of primary care services.

Currently, NYS spends $10,000 per New Yorker in health care costs—20% higher than the national average and the eighth highest in the nation. New York’s health care costs per resident are the second highest in the country. However, this massive investment has not paid off in outcomes; despite its high spending, New York does not rank among the top 10 states for health indicators such as cardiovascular deaths, diabetes, health disparities, frequent mental distress, preventable hospitalizations, rates of infectious diseases, chlamydia, pertussis, physical inactivity, drug deaths, and excessive drinking, according to 2018 data. If we stay on this concerning trajectory, New York will fall further behind, producing sicker, more chronically ill people, worsening health disparities, and continually rising health care costs.

It is in this context that PCDC believes that New York should work to realign our health care system through a deliberate strategy to define, measure, report on, and increase the proportion of the health care dollar allocated to primary care.