Is Primary Care Effective? QUANTIFYING THE HEALTH BENEFITS OF PRIMARY CARE PHYSICIAN SUPPLY IN THE UNITED STATES

This analysis addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States? A search of the PubMed database for articles containing “primary care physician supply ” or “primary care supply ” in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care physicians per 10,000 population. Primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980–1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year. Forecasting the need for physicians is generally based on task and time projections (1) and benchmarking with health maintenance organizations rather than on assessments of the likely contributions to improving health (2). In the 1990s, these approaches predicted physician surpluses in the 2000s. However, recent analyses using macroeconomic projections of demand for health services predict physician deficits of as many as 200,000 by 2025 (3). As a consequence, the Council on Graduate Medical Education reversed its position that the United States is producing too many physicians, and it has now endorsed the view that the nation may, in fact, be producing too few (4). The purpose of this article is to summarize existing studies of the likely effect of primary care physician supply on a variety of health outcomes. It addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States