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Comment & Response
February 11, 2020

Increasing Spending on Primary Care to Reduce Health Care Costs

Author Affiliations
  • 1Family Medicine Residency Program, JPS Hospital, Fort Worth, Texas
JAMA. 2020;323(6):571. doi:10.1001/jama.2019.20634

To the Editor Dr Song and Mr Gondi1 described the failure of recent efforts to increase total primary care spending to reduce total health care costs of the population. However, they did not explain why the studies they reviewed failed.

In each of these studies, the major changes involved expanding the teams, adding care navigators, health coaches, social workers, integrated behavioral professionals, and others. The extra personnel costs would increase the overhead costs of these practices, offsetting the savings produced from the small decrease in emergency department visits and hospitalizations. None of these studies addressed the observations that the supply of family physicians in an area is associated with better health outcomes at a lower cost. The limited data on general internists suggest that an increasing supply is associated with higher costs.2 Almost all of the primary care studies included family physicians or their European general practitioner counterparts, not general internists or pediatricians.

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