Use of Primary Care Among Workers and Dependents With Employment-Based Health Coverage: A Longitudinal Analysis

Summary

Through the provision of workplace health benefits, employers not only attract high-quality employees, but also play a role in facilitating primary care use. Coverage of primary care through employment-based health plans helps employees stay healthy and can reduce the risk of serious health problems that can lead to high health care costs and lost productivity. In this Issue Brief we discuss efforts by employers to make primary care more accessible and affordable for their employees, such as offering direct primary care plans and work-site clinics, as well as state and federal level policies to increase the primary care work force. Using claims data from 2013–2021, we document how changes in primary care location and provider type have changed over time and coincide with these private- and public-sector policy changes. Finally, we show how the usual source of care has changed over time by age, gender, race, education, and socioeconomic status using data from the 2013–2020 Medical Expenditure Panel Survey (MEPS). We find:

• Among users of primary care, 95–97 percent utilized it in an office setting prior to 2020, but only 86 percent did so from 2020–2021 as employees began using telemedicine (7–8 percent) and urgent care clinics (3–4 percent) with greater frequency due to the COVID-19 pandemic.
• There has been a consistent downward trend in the share of employees whose primary care office visits are at a general/family practice, falling from 42 percent in 2013 to 37 percent in 2021. In addition, primary care office visits at internal medicine providers have fallen from 21 percent in 2013 to 17 percent in 2021. Finally, provision of primary care by a medical doctor has fallen from 9 percent in 2013 to 4 percent in 2021.
• In contrast, primary care provision by nurse practitioners and physician assistants has risen over time. The share of employees whose primary care office visits have been with a physician assistant rose from 2 percent in 2013 to 6 percent in 2021. The corresponding change for nurse practitioners has been from 4 percent in 2013 to 16 percent in 2021.
• The share of workers reporting a usual source of care has fallen from 2013–2020 and has occurred for all workers regardless of gender, race, age, education, or income.
• The decline in primary care office visits at general/family and internal medicine practices demonstrated by claims data is consistent with the decline in general/family and internal medicine practices being the usual source of care reported in the MEPS as are the increases in primary care provision by nurse practitioners and physician.
• Young, lower-income workers with some college, an associate’s degree, or a bachelor’s degree are driving the trends in usual source of care away from general practices. Young workers with high levels of education and income are driving the trends in usual source of care away from internal medicine practices. Middle-aged workers with intermediate and high levels of education and income are driving the trends in usual source of care toward nurse practitioners. Finally, the rise in physician assistants as the usual source of care has been seen across all types of workers to a similar degree.