Care demand likely to outstrip supply

A study released online by Health Affairs on Feb. 20 finds that, with expansion of insurance coverage under the Affordable Care Act (ACA), 7 million Americans live in areas where demand for primary care services will exceed the supply of providers by more than 10 percent.

Overall, according to the study, 44 million people live in areas where the projected increase in demand for primary care providers is greater than 5 percent of current baseline supply.

With the national average for this shortage expected to be in the range of 1.5-2.4 percent, co-authors Elbert S. Huang and Kenneth Finegold wrote that the study highlights "the need to promote policies that encourage more primary care providers and community health centers to practice in areas with the greatest expected need for services."

Huang is affiliated with the Pritzker School of Medicine at the University of Chicago; Finegold is an analyst in the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health & Human Services.

To arrive at their conclusions, the authors studied the variation in primary care service areas as originally defined by the Dartmouth Atlas group. The authors estimated the number of uninsured in each primary service area in 2010, the number of people expected to gain insurance as a result of the ACA, and the number of providers that would be needed to serve the newly insured.

The researchers also cited a recent study by Adam Hofer and colleagues, which estimated that the United States will need between 4,307 and 6,940 additional primary care physicians to meet new demands created by insurance coverage expansion under the ACA.

Huang and Finegold wrote:

"If there were no change in the organization or delivery of healthcare, Hofer’s results suggest that we would need an increase of approximately 2.0–3.0 percent in the supply of primary care providers to satisfy the increased demand from the newly insured. Working on the assumption that nurse practitioners and physician assistants will meet part of that increase in demand, we anticipate that there will be a 1.5–2.4 percent increase in demand for primary care physicians."

The potential strain on the primary care workforce will be greater in some states than in others based on the number of uninsured and existing primary care capacity. The largest increases in demand are expected in Texas, Mississippi, Nevada, Idaho and Oklahoma.

The co-authors said that identifying areas of expected increased demand for primary care services "will contribute to formulating policy responses, potentially including the targeting of National Health Service Corps Scholarship and Loan Repayment Program funds to those areas, or providing additional incentives through vehicles such as the Medicare Physician Bonus Payment Program."

This study will also appear in the March issue of Health Affairs.