National Academies Press: OpenBook

Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (2021)

Chapter: Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015

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Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×

Appendix C

Committee’s Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015

Assumptions:

Rural population: 46 million (Cromartie et al., 2020)

U.S. total population: 331 million (U.S. Census Bureau, 2021)

Life expectancy: 78.6 years (Arias and Xu, 2019)

Loss of primary care physicians (PCPs) from rural counties between 2005 and 2015: –7.0 per 100,000 population (Basu et al., 2019)

Loss of PCPs in the United States overall between 2005 and 2015: –5.2 per 100,000 population (Basu et al., 2019)

+10 PCPs per 100,000 population is associated with an increase of 51.5 days of life expectancy per person (Basu et al., 2019)

IMPACT OF LOSS OF PRIMARY CARE PHYSICIANS IN RURAL COUNTIES, 2005–2015

If +10 PCPs per 100,000 population = 51.5 days of gained life per person

–7 PCPs per 100,000 population = 51.5 × .7 = 36.05 days of potential life lost per person

46 million people × 36.05 days = 1,658,300,000 days of potential life lost between 2005 and 2015

Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×

1,658,300,000 days / 365 = 4,543,287 years of potential life lost between 2005 and 2015

4,542,287 / 10 = 454,328 years of potential life lost per year

454,328 years of lost life per year / 365 days = 1,245 years of potential life lost per day

454,328 years of life lost per year; 1,245 years of potential life lost per day

If the average life expectancy is 78.6 years, 454,328/78.6 = 5,780 potential lives lost per year 1,245 per day / 78.6 = 15.84 potential lives lost per day

IMPACT OF LOSS OF PRIMARY CARE PHYSICIANS IN THE UNITED STATES, 2005–2015

If +10 PCPs per 100,000 population = 51.5 days of gained life per person

–5.2 PCPs per 100,000 population = 51.5 × .52 = 26.78 days of potential life lost per person

331 million people × 26.78 days = 8,864,180,000 days of potential life lost between 2005 and 2015

8,864,180,000 / 365 = 24,285,425 years of potential life lost between 2005 and 2015

24,285,425 / 10 = 2,428,543 years of potential life lost per year between 2005 and 2015

2,428,543 / 365 days = 6,654 years of potential life lost per day

2,428,543 years of potential life lost per year; if the average life expectancy is 78.6 years, 2,428,543 / 78.6 = 30,897 lives lost per year; 6,654 / 78.6 = 85 lives lost per day

A typical commuter plane carries 200 passengers (180 passengers in a Boeing 757; 250 passengers in an Airbus); 200 passengers / 85 lives lost per day = roughly one 200-person plane crashing every 2–3 days

Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×

REFERENCES

Arias, E., and J. Xu. 2019. National vital statistics reports: United States life tables, 2017 (vol. 68, no. 7). Hyattsville, MD: National Center for Health Statistics.

Basu, S., S. A. Berkowitz, R. L. Phillips, Jr., A. Bitton, B. E. Landon, and R. S. Phillips. 2019. Association of primary care physician supply with population mortality in the United States, 2005–2015. JAMA Internal Medicine 179(4):506–514.

Cromartie, J., E. A. Dobis, T. P. Krumel, D. McGranahan, and J. Pender. 2020. Rural America at a glance: 2020 edition. Washington, DC: U.S. Department of Agriculture.

U.S. Census Bureau. 2021. U.S. and world population clock. https://www.census.gov/popclock (accessed January 13, 2021).

Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×

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Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
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Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 410
Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 411
Suggested Citation:"Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 412
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High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.

Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern.

Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs.

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