The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
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The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
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We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
July 25, 2017 | Michael H. Bailit, Mark W. Friedberg, and Margaret L. Houy
Total Costs of Care
Primary care is often acknowledged as the foundation of any high-performing health care delivery system. But how much of our health dollars go to supporting it?
To address this question, the authors of this report—Michael Bailit, Mark Friedberg, and Margaret Houy—present a methodology to define and estimate spending on primary care, relative to other medical expenses. The study design first focused on developing consensus on a specific definition of primary care (including provider types and service billing codes) and then established the feasibility of applying this measure using data from a set of commercial insurers.
Primary care spending is a simple and easily understood measure of how oriented a delivery system or geographic community is to primary care, prevention, and population health. Given the proliferation of enhanced payment initiatives, there seems to be growing consensus in favor of increased spending for primary care and the idea that primary care is a necessary, fundamental step toward a better-performing health system. And we want to increase policy focus on it.
This report shows the importance of precisely defining primary care spending—and provides additional questions for future research. With further development and validation, these measures of primary care spending could serve as the basis for national benchmarks and public policies that seek to orient health systems more strongly toward primary care.
Resource file (PDF)
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
State Models for Health Care Cost Measurement: A Policy and Operational Framework
April 8, 2015
2002-2003 State Health Expenditure Report
November 25, 2005