President's Message

March 18, 2020

Sabina Singh, MD – WAFP President

Sabina Singh, MD – WAFP President

“Primary Care Investment”

Understanding Primary Care Investment is important as we continue to improve our healthcare system. Greater spending on primary care services has been associated with lower costs, higher patient satisfaction, fewer hospitalizations, fewer emergency department visits, and lower mortality. The push for increased investment in primary care is advancing across the country.   As of February 2020, ten states are pursuing or have enacted legislation mandating the state level of primary care spending.

To understand Primary Care Investment, we must first understand a key definition: what constitutes primary care? The Starfield definition includes the 4C’s : first contact, continuous, comprehensive, and coordinated care.  When it comes to analyzing primary care spend, “Narrow” definitions of primary care providers include family medicine, internal medicine, and pediatric physicians practicing in ambulatory settings. “Broad” definitions are generally expanded to include nurse practitioners, physician assistants, geriatricians, OB-gyns, and behavioral health professionals.

Evidence shows that primary care-oriented systems achieve better health outcomes, more health equity, and lower costs.  According to The Primary Care Collaborative’s 2019 Evidence Report, the US spends 5-7% of total health care spending on primary care. In 2019 the Patient-Centered Primary Care Collaborative executive summary (the full report is available here) states that the national average for primary care investment is 5.6% using the narrow definition and 10.2% using the broad definition, with significant variability among states. Estimates for Wisconsin’s primary care spending are at 6.2% using the narrow definition, and 11.1% using the broad definition. Click here for a deeper look at how other states are doing on Primary Care Investment and what they are doing about it. 

While Wisconsin does not have any legislation or mandates in our foreseeable future, Primary Care Investment is necessary for our patients and for ourselves as family physicians. It is an issue that both our board of directors and legislative committee are continuing to evaluate. If you’d like to get involved in this important issue, please contact us.


Sabina Singh, MD
WAFP President

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