Estimating Primary Care Spending in the United States: Toward a Common Method

The lack of common definition and methods, coupled with the scarcity of suitable data sources, have impeded efforts to track primary care spending in the United States.

Explore consistent approaches to estimating primary care spending.

A recently developed framework for primary care services was applied to 2 datasets: the Medical Expenditure Panel Survey (MEPS), a survey of noninstitutionalized individuals and their families in the United States, and MarketScan, a database containing health insurance claims of employees and their dependents for a selection of major US companies, to estimate primary care spending per-person-per-year (PPPY) and as percentage of total health care spending (PTHS) covering 2010-2021. Cross-sectional and trend analyses were conducted, and key methodological issues were explored.

In 2019, average primary care spending was $504 PPPY (95% CI: $469-$539), accounting for 8.07% PTHS (95% CI: 7.56%-8.58%), based on MEPS, and $378 PPPY (95% CI: $377-$379), accounting for 6.30% PTHS (95% CI: 6.28%-6.32%), based on MarketScan. There were steady increases between 2010 and 2021 in PPPY primary care spending (from $309 to $639 based on MEPS and from $343 to $433 based on MarketScan), but small fluctuations in PHTS primary care spending (between 6% and 9%). Misalignments between the definitions and the data were identified, and standard errors for the estimates were calculated.

With explicit definitions, transparent methodologies and appropriate quantification of estimation uncertainty, comparable and reproducible estimates can be obtained to assess and track primary care spending in the United States.