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Comment & Response
August 28, 2018

Comparing Spending on Medical Care in the United States and Other Countries

Author Affiliations
  • 1The Robert Graham Center, Washington, DC
JAMA. 2018;320(8):839. doi:10.1001/jama.2018.8004

To the Editor Health care in the United States has an undeniable pricing problem, highlighted in the Special Communication by Dr Papanicolas and colleagues.1 We disagree, however, with statements in the article about whether relatively higher US spending might partially be explained by low primary care to specialist mix.

The study relied on workforce estimates that are outliers relative to other US physician workforce analyses. The Kaiser Family Foundation web source referenced used data from the commercial company Redi Data to count 951 061 licensed physicians in the United States, 456 389 (43%) of them classified as primary care.2 These numbers deviate substantially from other contemporary estimates. For example, the Association of American Medical Colleges (AAMC), using data from the American Medical Association Physician Masterfile, counted 782 200 physicians in direct patient care in 2016, with 221 2000 (28.3%) in primary care.3 The Bureau of Labor Statistics counted 713 800 physicians in 2016, 195 220 (27.3%) in primary care.4 Lack of published methods makes the Kaiser Family Foundation estimates difficult to reproduce, but their estimated 188 277 general internists exceed federal (Health Resources and Services Administration) estimates5 of 65 600 general internists and 205 000 primary care physicians by enough to suggest inclusion of retirees, administrators, teachers, researchers, and residents, most of whom ultimately specialize.

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