Over the past 15 years, the Affordable Care Act (ACA) has made preventative care more accessible through expanded insurance coverage and eliminating cost sharing for preventive visits.  This has resulted in a higher proportion of primary care visits with a preventive focus versus a problem-based focus.  As a result, overall, adults are visiting their primary care physicians less frequently. 

While preventative care is beneficial in building patient-doctor relationships, identifying health issues, and improving health outcomes, especially for high-risk individuals, there remains some question regarding how necessary these visits are, and how often they should occur.

A recent study in Health Affairs by Professor of Health Care Policy, Bruce Landon, MD, MBA, MSc and coauthors measures the impact of recent policy initiatives on the delivery of preventative care by addressing the following questions.

1. How has the proportion of primary care visits focused on preventative care changed over time?
2. What are the differences in visits length and issues addressed between preventative and problem-based primary care visits?
3. How do the services provided during preventative visits compare to those in primary care visits without preventive focus?

Using National Ambulatory Medical Care Survey (NAMCS) data collected from 2001-2019, they examined outpatient visits to primary care physicians and focused on the purpose and outcome of these visits.

Findings revealed that the proportion of primary care visits with a preventive focus nearly doubled from 2001-2019. The study also found that visits with a preventive focus tended to be longer, more likely to include counseling, and were associated with increased use of preventive labs and imaging procedures. The study suggests that the increasing preventive visits was made possible by insurance coverage expansion, such as the ACA, which improved access for preventive care. The nature of these visits allowed physicians to take are more comprehensive approach in addressing latent problems before they become urgent; however the decline in problem oriented visits suggests that overall access to primary care has declined and that patients are likely filling these needs with visits to other settings such as urgent care or the ED, or not pursuing care at all.