Demand for primary care services will rise by 18% between 2013 and 2023 under current law conditions, according to a report from Congressional Budget Office.

“That increase is caused primarily by growth in the size of the population,” CBO analysts said in the report . “Larger gains in health insurance coverage and more rapid aging of the population explain why the increase is expected to be larger than the 15.5% rise of the previous decade.”

While the report assumes continuation of Affordable Care Act programs, insurance coverage is the smallest component of the 18% rise, according to the CBO.

Drivers of the increase include:

The analysis echoes modeling of primary care demand done by the American Academy of Family Physicians.

“Most people were imagining that the Affordable Care Act would be the biggest driver of increased primary care demand,” Andrew Bazemore, MD, director of the AAFP’s Robert Graham Center for Policy on Family Medicine and Primary Care, said in an interview. “In this case, the biggest driver is population growth. The smallest of those three factors is expanding insurance.”

The CBO report does not offer a specific forecast on whether the supply of primary care physicians will meet the increased demand, but it does offer a number of policy options to increase the supply of primary care doctors.

“Such options include paying more for primary care through Medicare or Medicaid, subsidizing more residencies in primary care, helping repay loans held by medical students who agree to pursue primary care, and making it easier for foreign doctors to practice in the United States,” the report states.

Dr. Bazemore concurred with the options. “I think that is a very reasonable summary,” he said.

In particular, he noted that the payment discrepancy between primary and specialty care is a key concern when it comes to primary care shortage.

“If you have big gaps in income between subspecialists and primary care, you have more students making the former choice rather than the latter,” he said. The gap could be closed many ways, such as providing primary care bonus payments, revaluing the evaluation and management codes, blended payment models, or alternate payment models that are coming out that allow primary care providers to share in savings for improving population health.

“If you can’t narrow that gap, you won’t get more primary care physicians,” he said.

The CBO analysis is based on insurance coverage projections as of March 2016 and assumed continuation of Affordable Care Act programs. The authors noted that “changes to the ACA, including repeal or replacement, would yield different levels of insurance coverage and thus different effects on demand for primary care.”


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