Barnard Mason, Figueroa Jose F, Phelan Jessica, Orav E John, Papanicolas Irene
Department of Sociology, Princeton University, Princeton, NJ 08544, United States.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States.
Health Aff Sch. 2025 Jun 30;3(7):qxaf127. doi: 10.1093/haschl/qxaf127. eCollection 2025 Jul.
Scholars express concern that general practitioner shortages and specialist surpluses induce overspecialization, with overuse of costly specialist services and underuse of cost-effective primary care services. Yet few studies directly assess the relationship between physician supply and patient utilization. Given this gap, this paper examines the associations between physician supply, care utilization, and patient need and whether patients use more specialists in areas with lower primary care supply.
Using a 20% sample of 2018 Medicare fee-for-service claims, this paper first assessed the correlation between county physician densities and county physician visits. It then modeled individual patient consumption of primary and specialty care services in relation to physician supply through linear regression, adjusting for health and demographics.
While county supplies of primary care practitioners (PCPs) and specialists were positively correlated, we found no correlation between local PCP supply and local primary care visits. We also found no evidence that patients substitute specialist care for primary care, even in areas with PCP shortages.
These findings suggest that factors other than PCP supply play an important role in primary care underuse. Scholars should also consider how care models, limited gatekeeping, and excess consumption among well-resourced populations influence the distribution of primary care utilization.
学者们担心全科医生短缺和专科医生过剩会导致过度专业化，出现昂贵的专科服务使用过度而具有成本效益的初级保健服务使用不足的情况。然而，很少有研究直接评估医生供应与患者医疗服务利用之间的关系。鉴于这一空白，本文研究了医生供应、医疗服务利用和患者需求之间的关联，以及在初级保健供应较低的地区患者是否会更多地使用专科医生。
本文使用2018年医疗保险按服务收费索赔数据的20%样本，首先评估了县医生密度与县内医生就诊次数之间的相关性。然后通过线性回归，针对健康状况和人口统计学因素进行调整，建立了个体患者的初级保健和专科保健服务消费与医生供应之间的模型。
虽然初级保健从业者（PCP）和专科医生的县供应呈正相关，但我们发现当地初级保健从业者供应与当地初级保健就诊次数之间没有相关性。我们也没有发现证据表明患者会用专科护理替代初级护理，即使在初级保健从业者短缺的地区也是如此。
这些发现表明，除初级保健从业者供应之外的因素在初级保健利用不足方面起着重要作用。学者们还应考虑护理模式、有限的守门制度以及资源丰富人群的过度消费如何影响初级保健利用的分布。
