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May 9, 2023
Primary Care Transformation Health Equity
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When adequately supported and designed, high-quality primary care is a common good that provides better population health and more equitable outcomes, according to the National Academies of Sciences, Engineering, and Medicine (NASEM).
But primary care in the United States has been under-resourced for decades, especially in Black, Indigenous, and other historically marginalized communities, resulting in a depleted workforce struggling to deliver care in a weakened infrastructure. The first National Primary Care Scorecard released in February underscores this reality and demonstrates that our current primary care policies are not adequately supporting the delivery of high-quality primary care.
Recognizing this, the federal government recently launched the Health and Human Services Initiative to Strengthen Primary Health Care, and 17 states are adopting legislation to increase investment in primary care. A new report, sponsored by the California Health Care Foundation (CHCF), summarizes decades of research that demonstrate the link between primary care and improved health equity. In this report we argue that more needs to be done – and done differently – to rebuild the foundation of our health care system in an equitable way.
Our CHCF-sponsored report calls for new ways of thinking and acting as we work to strengthen primary care and ensure these efforts prioritize equity:
Primary care access, quality, and resources vary widely between communities. These disparities reflect decades of differential investment and fall most heavily on disadvantaged communities, including those at highest risk for health inequities, such as Black, American Indian and Alaska Native populations. More investment in primary care is needed. Any future programs and investments must advance equity in primary care. Specific solutions will (and should) vary across states, but here are four overarching policy principles:
To forge a path toward health equity, innovative primary care policies and investments are needed in communities across the United States, and a one-size-fits-all approach will not suffice. Strengthening primary care in a way that assures equity for patients, communities, and healthcare workers will require a radical reorientation of payment and policy.
We encourage decision-makers to use new policy levers, or use old levers in new ways, asking these questions:
In addition, infrastructure investments can take many different forms. Two possibilities to consider are:
As a common good, primary care should be promoted, protected, and monitored by responsible public policy and supported by private-sector action. Progress is possible. And the time is now.
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