Prevention happens when people can see a primary care doctor for regular check-ups and basic care. However, the U.S. spends only about 5 cents of every health care dollar on primary care. Other high-income countries spend three times that much. This chronic underinvestment creates a cascade of problems.
Why Does This Happen?
Unlike other high-income countries, the U.S. chronically under-invests in primary care. We’re training fewer primary care doctors and paying primary doctors less because other specialties are more lucrative.
How Much Money Gets Wasted?
About $13 billion annually is spent treating medical problems late rather than catching them earlier.
How It Hurts Patients
Routine health problems like diabetes and asthma can spiral out of control without early interventions. This results in costly hospitalizations and poorer quality of life down the line.
We Starve Primary Care
Primary care doctors are paid less than other doctors , so medical students choose higher-paying specialties instead. Medical schools don’t create enough primary care residency slots because hospitals make more money training specialists. Between training shortfalls and other barriers, California now has over 11 million residents living in areas with officially recognized primary care shortages.
On top of workforce shortages, patients may find that some doctors don’t take their insurance, aren’t open the hours they need, or are located too far away. Wait times can stretch for weeks or months.
All of this means that people can’t get the regular care they need. And that means that predictable problems like diabetes and asthma complications, can spiral out of control. In 2022, more than 240,000 hospital stays in California could have been avoided with basic preventive care.
It’s like having too few fire stations: By the time help arrives, small problems have become major crises — and the cost to repair the house has skyrocketed.
Invest More in Primary Care Now, Save Later
California can fix this by flipping the script — investing more money upfront in primary care to save even more money down the road because people are healthier.
Here’s what this looks like in real life:
- To prevent colon cancer, regular screening catches problems before they become serious cancer.
- To prevent heart disease, regular check-ups prevent expensive emergency room visits and hospital stays.
- To prevent diabetes, early treatment prevents costly complications like kidney failure and amputations.
A groundbreaking study covering almost 14 million Californians found that commercial health plans that spent more on primary care delivered better quality care and had fewer hospital visits. This reflects other research that has consistently shown that more primary care is associated with:
- Patients getting better care and living longer
- Fewer people ending up in emergency rooms or need expensive hospital stays
- Lower overall health care costs
Failures in prevention and care coordination are estimated to cost California’s health care system almost $13 billion a year. Imagine if that money could stay in California families’ pockets while they get better care though a more robust primary care system?
Specific Solutions for California
Health care regulators, patient advocates, employers buying health insurance for workers, health care providers and health plans are coalescing around various efforts to boost primary care in California. Some of the most important are:
- California’s Office of Health Care Affordability has set the goal that health plans allocate 15% of their total spending to primary care by 2034. The first OHCA report on plans’ progress toward meeting the goal is expected in 2026.
- Various workforce initiatives are underway in California to train more primary care providers, encourage service in rural areas, and add roles such as community health workers, nurses, and behavioral health providers so that primary care teams can serve more patients.
- Some of California’s largest public health care purchasers, including CalPERS and the California Department of Health Care Services, have aligned contract provisions with health plans to encourage more investment in primary care and better access to services.
