Demand for primary care is projected to rise slightly faster between 2013 and 2023 than in the previous decade. The paper outlines a number of ways—with and without federal intervention—in which supply might respond to rising demand.
By Noelia Duchovny (CBO), Sam Trachtman (formerly of CBO), and Ellen Werble (CBO)
Policymakers and other observers have raised concerns that demand for primary care services will exceed supply, which could adversely affect people’s health and might also increase total spending on health care. Defining demand as the amount of primary care that people received, we estimate that the general U.S. population demanded about $70 billion worth of services from primary care doctors in 2013. After being adjusted for general price inflation, that represents a 15.5 percent increase since 2003—when demand totaled about $61 billion (in 2013 dollars). We defined demand in the future as the amount of primary care physicians’ services that the population (given its size, age distribution, and insurance status) would receive if the volume and intensity of services used per person grew at the same rate that they did from 2003 to 2013—and also if growth in the prices of primary care services matched economywide inflation. We expect that such demand will increase by 18.0 percent between 2013 and 2023, to about $83 billion (also in 2013 dollars). Overall population growth accounts for about half of that increase, with population aging, gains in insurance coverage, and other sources of growth in the volume and intensity of services used per person each playing important but smaller roles. However, larger gains in health insurance coverage and more rapid population aging explain why the percentage increase in demand during the 2013–2023 period is somewhat larger than the increase during the previous decade. Whether the supply of primary care services will rise to meet the demand is unclear, but such an analysis is beyond the scope of this paper. Nevertheless, we outline a number of ways in which supply might respond to the rising demand for primary care with and without federal intervention, though we do not attempt to quantify them.
Those calculations reflect the projections of health insurance coverage that the Congressional Budget Office made in March 2016 and thus capture the effects of the Affordable Care Act that the agency expected at that time. Changes to that law, including its repeal or replacement, would yield different levels of insurance coverage and thus different effects on demand for primary care. Nonetheless, the calculations in this paper illustrate the relationship between coverage and demand and indicate which factors affecting future demand, coverage among them, are stronger and which are weaker.