Multibillion-dollar corporations like CVS Health, Amazon, UnitedHealth, and Humana, are taking over primary care practices at a rapid pace.
Estimates from the peer-reviewed journal Health Affairs point to corporations investing as much as $50 billion in primary care, which breaks down to upwards of $50,000 per patient.
For years there have been concerns over the shortage of primary care physicians in the United States.
Despite these physicians playing a key role in keeping Americans healthy, the poor working conditions they tend to face lead many to burn out, according to Harvard Health Publishing.
Primary care physicians are reportedly overworked by high patient quotas and underpaid, resulting in a burnout rate of as high as 79% in 2019. If the current trends continue, the country is expected to face a shortage of primary care physicians as high as 55,000 in 10 years as the population ages.
Despite this brewing problem, primary care physicians form the backbone of the healthcare system by managing patients’ health, performing regular check-ups, and acting as “gatekeepers” to an array of health services.
The latter is one reason why corporations are seeing primary care practices as an opportunity for profit, according to The New York Times. Primary care doctors oversee a large pool of patients who might bring their business to a hospital system, health insurer, or pharmacy looking to expand.
Another reason is the growing privatization of both Medicare and Medicaid, which are federal health insurance programs for senior citizens and others with certain disabilities or conditions.
“That’s the big pot of money everyone is aiming at,” Erin C. Fuse Brown, a health law professor at Georgia State University, told The New York Times. “It’s a one-stop shop for all your health care dollars.”
For instance, Humana, the third-largest health insurance provider in the world, announced earlier this year that it would focus only on federally funded programs instead of commercially funded ones.
“With employer-based coverage largely stagnant, public programs are the main source of revenue and profit growth for insurance companies,” Larry Levitt, executive vice president of the Kaiser Family Foundation, said, explaining Humana’s decision, according to Axios.
More than half of Medicare’s 60 million beneficiaries have signed up for private insurer policies through the Medicare Advantage program, according to The New York Times. This arranges full-risk, value-based contracts with insurers and doctors that offer a flat fee for patient care.
Some, like the Centers for Medicare & Medicaid Services, argue that this type of contract with insurers incentivizes the provision of high-quality care to patients, regardless of their health history or income level.
For instance, Social Security beneficiaries may have trouble covering their healthcare premiums next year, as estimates of the 2024 cost-of-living adjustment are relatively low, as The Dallas Express reported.
More broadly, an estimated 100 million Americans have medical debt, according to The Washington Post. In the majority of recorded cases, this debt was incurred in a one-off hospital visit or a short-term health crisis.
On the other hand, some studies have suggested that full-risk value-based contracts offering flat rates do not lead to better health outcomes for patients, according to Health Affairs.
Moreover, some have criticized these private Medicare Advantage plans, claiming they rack up profits by inflating costs or exaggerating patients’ illnesses to charge the government more than they should, according to The New York Times.
The federal government is now spending $400 billion a year on those insurers.
As The Dallas Express reported, this high cost has in part driven state authorities — like the Texas Health and Human Services Commission — to reassess Medicaid eligibility for their residents.
In addition, the frenzy for these value-based contracts increasingly makes them accessible to only the nation’s largest corporations or hospital groups.
As of 2021, nearly seven out of 10 of all doctors were either employed by a hospital or a corporation, according to an analysis from the Physicians Advocacy Institute.
For some doctors, the result has been a more profit-driven practice of care as opposed to a patient-focused one.
“You don’t become a physician to spend an average of seven minutes with a patient,” Dr. Dan Moore, who has his own practice in Virginia, told The New York Times.