Published in the Journal of General Internal Medicine. Here is a link to the article.
Regenstrief Institute authors: David Haggstrom, M.D., MAS, Matthew Bair, M.D., M.S.
Dr. Haggstrom answers questions about the role of primary care in improving survival and informing health policy.
What is the most important takeaway you want readers to understand about primary care and survival?
An important message is that primary care is associated with longer survival among a nationally representative population, and this finding reinforces decades of previous research. With the urgency around stagnant life expectancy in the US, healthcare leaders and policymakers cannot continue to overlook the foundational importance of primary care to individual and population health.
The study you highlight found that primary care access is associated with longer life expectancy. What stood out most to you about these findings?
The magnitude and persistence of the association was notable. Even after adjusting for a wide range of demographic, clinical, and social factors, individuals with a usual source of care had meaningfully longer survival, on the order of more than two additional years. It is notable that this signal remains detectable despite the many competing determinants of mortality, which speaks to the robustness of the primary care influence.
Beyond screenings and prevention, what aspects of primary care most contribute to better outcomes?
Evidence-based screening and prevention is important, but do not fully explain the benefit of primary care. Core features of primary care—comprehensiveness, coordination, and a person-centered approach—are harder to measure but may very well play a key role. In the editorial, we call this “good doctoring”.
You note that primary care access is declining in the U.S. What are the biggest drivers behind this trend, and what are the real-world consequences?
The causes are multifactorial, but chronic underinvestment is a central driver. Payment models continue to favor procedural and specialty care and fewer physicians are entering the field. The real-world consequences are worse outcomes and higher healthcare costs in the United States. We see what is possible in other high-income countries which perform better as a system with a higher proportion of the clinical workforce in primary care.
Why is this strong body of evidence still not fully reflected in U.S. health policy, and what changes could have the greatest impact?
There is a longstanding disconnect between evidence and policy, driven in part by entrenched and competing interests within the healthcare system. Primary care’s benefits are broad, longitudinal, and sometimes less visible than discrete interventions, which makes policy translation more challenging. The changes with the greatest impact would include sustained investment in primary care infrastructure and data systems. Continued research is needed to track and guide progress.
If you could prioritize one immediate change to strengthen primary care in the U.S., what would it be?
Rather than any single change, progress will likely come from alignment between federal policy and state-level innovation. Federal actions are very important, such as advancing payment reform in Medicare and Medicaid and investing in primary care infrastructure and workforce. At the same time, states are already serving as policy laboratories, testing new spending targets and care models. Aligning and scaling what works across these efforts should be a key priority of healthcare policymakers.
Affiliations
1VA HSR Center for Health Information and Communication, Indianapolis VA Medical Center, Indianapolis, USA.
2Division of General Internal Medicine & Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
3William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.
4VA HSR Center for Health Information and Communication, Indianapolis VA Medical Center, Indianapolis, USA.
5Division of General Internal Medicine & Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
6William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.
