Primary Care Is Hurting: Why Aren't Private Insurers Pitching In?
Primary care clinicians are the front line for patients with suspected infection. We rely on them to diagnose, triage, and manage patients with potential or confirmed COVID infections. They are also responsible for keeping non-COVID medical conditions under control while patients maintain social distancing.
This central role makes it of even greater concern that primary care practices are far more financially vulnerable than other medical specialties, where margins are higher and pockets deeper. Only half of primary care clinicians report enough cash to stay open for the next four weeks. The potential outcomes are grim: practices will go under, patients will lose access, and, when the dust settles, more clinicians will either leave primary care or seek employment in hospital-owned or large groups with greater reserves. These acquisitions have been shown to raise prices and spending.
Supporting primary care is not only in the public interest; it’s in the interest of commercial health insurers. If primary care practices are decimated and absorbed, not only might patients receive more expensive specialty care in lieu of primary care, but insurers will have less ability to pick and choose “in-network” practices based on efficiency and pricing.
Commercial insurers have excess premiums due to the downturn in healthcare demand, and they could help to support this front line and strengthen our post-pandemic healthcare system in so doing. They would also would benefit from helping providers at a moment when the public perceives them to be sitting on the sidelines. But there is a free-rider problem to address: clinicians serve enrollees from multiple insurers. We propose a simple solution that would deliver funds where needed, and promptly.
This central role makes it of even greater concern that primary care practices are far more financially vulnerable than other medical specialties, where margins are higher and pockets deeper. Only half of primary care clinicians report enough cash to stay open for the next four weeks. The potential outcomes are grim: practices will go under, patients will lose access, and, when the dust settles, more clinicians will either leave primary care or seek employment in hospital-owned or large groups with greater reserves. These acquisitions have been shown to raise prices and spending.
Supporting primary care is not only in the public interest; it’s in the interest of commercial health insurers. If primary care practices are decimated and absorbed, not only might patients receive more expensive specialty care in lieu of primary care, but insurers will have less ability to pick and choose “in-network” practices based on efficiency and pricing.
Commercial insurers have excess premiums due to the downturn in healthcare demand, and they could help to support this front line and strengthen our post-pandemic healthcare system in so doing. They would also would benefit from helping providers at a moment when the public perceives them to be sitting on the sidelines. But there is a free-rider problem to address: clinicians serve enrollees from multiple insurers. We propose a simple solution that would deliver funds where needed, and promptly.
Keywords: COVID-19; Primary Care; Health Pandemics; Health Care and Treatment; Financial Condition; Insurance;
Citation:
Dafny, Leemore S., and J. Michael McWilliams. "Primary Care Is Hurting: Why Aren't Private Insurers Pitching In?" Health Affairs Blog (May 21, 2020). View Details