More care means lower costs?

The Commonwealth Fund recently published one of their very excellent issue briefs titled Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve? by James D. Reschovsky, Arkadipta Ghosh, Kate Stewart, and Deborah Chollet. This paper reports on a simulation model of the effects of improving reimbursement for primary care services (as Medicare did last year). Based on data showing that more primary care leads to lower total costs via lower rates of hospitalizations and other expensive services, the authors conclude that "promoting primary care can help bend the Medicare cost curve."

Other than rationing, getting patients into primary care is just about the only known way to reduce utilization. There are many ways to increase use of primary care services (such as automated systems to increase engagement between patients and providers), but none of them will work if there aren't enough primary providers. There is clearly a shortage of primary care providers now and it will only get worse as demand grows in the future due to improved insurance coverage and an aging population. If primary specialties aren't made more attractive by increasing payments (and lowering administrative burdens, too, while we are at it), we will never see an end to the health care cost crisis.