The impact of improving access to primary care

Abstract

ObjectivesTo measure the size and timing of changes in utilization and costs for employees and dependents who had major access barriers to primary care removed, across an 8‐year period (2007 to 2014).Study design and methodsRetrospective observational study examining patterns of utilization and costs before and after the implementation of a worksite medical office in 2010. The worksite office offered convenient primary care services with no travel from work, essentially guaranteed same day access, and no co‐pay. Trends in visit rates and costs were compared for an intervention fixed cohort group (employees and dependents) at the employer (n = 1211) with a control fixed cohort group (n = 542 162) for 6 types of visits (primary, urgent, emergency, inpatient, specialty, and other outpatient). Difference‐in‐differences methods assessed the significance of between‐group changes in utilization and costs.ResultsThe worksite medical office intervention group had an increase in primary care visits relative to the control group (+43% vs +4%, P < 0.001). This was accompanied by a reduction in urgent care visits by the intervention group compared with the control group (−43% vs −5%, P < 0.001). There were no differences in the other types of visits, and the total visit costs for the intervention group increased 5.7% versus 2.7% for the control group (P = 0.008).A sub‐group analysis of the intervention group (comparing dependents to employees) found that that the dependents achieved a reduction in costs of 2.7% (P < 0.001) across the study period.ConclusionsThe potential for long‐term reduction in utilization and costs with better access to primary care is significant, but not easily nor automatically achieved.

What explains the inequalities in health care utilization between immigrants and non-migrants in Switzerland?

“…Inadequate or inappropriate health care utilization of certain services may lead to poorer health, higher health inequalities, and higher healthcare expenditures [ 49 , 50 ]. Ensuring, for example, equal access to primary care, equal quality of care and orienting all patients efficiently through the healthcare system could increase preventive care and reduce unnecessary hospitalizations and ED visits [ 51 , 52 ].…”

Employer-Led Strategies to Improve the Value of Health Spending: A Systematic Review

“… 35 , 37 , 38 All four studies found statistically significant improvements in health outcomes; three of these studies did not result in higher spending (see Table 2 ). 35 , 36 , 38…”

“…In addition, only one article in our review analyzed the creation and implementation of an onsite medical office whereby employees and dependents could acquire preventive health care services with no copay. 36 The provision of onsite health care can be a tremendous investment for employers, but for employees and their families it can serve as an efficient conduit to care by removing obstacles such as travel, waiting periods, and payment. A 2018 Mercer survey found that a third of large employers with 5000 or more employees had established worksite clinics—an increase from 25% in 2012—and saw this as a valuable venture to address basic and chronic health problems in their workforce and keep medical costs down.…”

Physical health needs and self-reported health status among adults with autism

“…Reducing barriers to healthcare access, especially those related to adequate receipt of primary care, is critically important for this high-need population. Research has shown that primary care plays a significant role in being a gateway to the healthcare system, reducing future healthcare use, and overall better health outcomes (Glass et al, 2017; Shi, 2012; Starfield et al, 2005). Further research on how adults on the autism spectrum interact with healthcare systems is warranted.…”