Study shows effects of primary care on health utilization

A recent research study, published in a National Bureau of Economic Research (NBER) paper, examined the medical visit patterns of low-income patients. In particular, the researchers sought to determine whether cash incentives would encourage those patients to visit a primary care physician and whether that visit would subsequently result in lower healthcare costs and decreased emergency room (ER) visits for the target group.

In a follow-up to the original study regarding cash incentives and utilization, the team sought to “examine how the incentives affected health care utilization beyond the initial PCP visit.” In addition, the researchers set out to “assess whether an initial PCP visit changes utilization and spending, using the random assignment from the experiment to provide exogenous variation in PCP visit.”

As a result of both studies, the researchers are able to “provide new evidence on whether a low-cost investment in incentives can encourage desired health care utilization, and on whether primary care alters utilization patterns and reduces high-cost care in a low-income safety net population.”

They found that incentives did encourage the patients to visit their primary care physicians, both for an initial visit and for follow-up visits. They also found that the ER visits were modestly reduced for these patients, although outpatient visits actually increased within the first six months after the primary care visit.

Incentives were most effective in encouraging less-healthy patients to visit a primary care physician. The researchers found that their “results were not driven by relatively healthy subjects who could more easily avoid the ED than those who were in poor health.”

Surprisingly, healthcare spending increased slightly for the incentivized patients over the short term. It is expected, however, that decreased spending may occur over a longer period of time, as patients are better able to manage their chronic or complex conditions through continued and consistent visits to a primary care physician.