Primary Care and Universal Coverage

The Massachusetts Experience

As a result of the Patient Protection and Affordable Care Act, more than 30 million people are expected to be newly insured, many of whom will be seeking a source for primary care. At the same time, media reports and some studies are proclaiming a current or imminent shortage of primary care providers.

This Synthesis examines the evidence on the primary care workforce including: the supply and distribution of the workforce; the historical and projected demand on the primary care workforce; the effects of payment policies and scope of practice laws on the workforce; and how the primary care workforce is evolving.

Key Findings:

  • The maldistribution of primary care providers appears to be a larger problem than an overall shortage. Primary care providers tend to aggregate in suburban and urban areas at a higher rate than the overall population leaving rural and some poor, inner-city areas without an adequate supply of primary care providers.
  • Although a baseline of primary care providers is needed, there is no evidence that the supply of providers is correlated with improved quality of care.
  • Demand for primary care services will be driven by the aging population and the overall growth rate of the population, in addition to the increased number of people with insurance.
  • Although state scope of practice laws have expanded, allowing non-physicians–particularly nurse practitioners–to perform more primary care services, there is a high degree of variability across states and even within a given state.
  • Finally, new practice models may be as important as the supply of primary care providers in meeting the nation’s primary care needs.

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