Does Primary Care Actually Save Money?


One of the arguments for Obamacare has been the claim that increased access to primary care will result in long-term cost savings, but studies show conflicting results.  The theory in favor of this is that early detection will allow treatment in earlier stages.  The theory opposed to it is that keeping people alive costs money, as well.

Still, before we commit to a government takeover of health care, isn’t there a pretty simple experiment that we could run to find out?  If access to primary care really does save money in the long run, why aren’t insurance companies providing incentives to the insured to make more and better use of their PCPs?  There are some experiments in the works to incentivize doctors to be more accessible, and Anthem is even cutting them in on the presumed savings.

But the problem may be on the demand side as well – people just don’t like going to doctors, and not only because of the wait times.  Presumably the problem isn’t just putting off going to the doctor when you’re sick, it’s also putting off the routine physical or the annual checkup that could catch trouble early, before there are any symptoms at all.  So why not cut the co-pays?  Or why not mimic the safe-driver discounts and rebate an increasing portion of the co-pay for every year you go for your physical?  The latter would also help create the habit of going to the doctor regularly.

Insurance companies live and die on the sort of actuarial math that would let them detect any positive results from these experiments pretty quickly.  And if anyone is culturally geared not to fall for the fallacy of the seen and the unseen, it’s insurance companies.  (The fallacy states that people fall for redistributionist schemes because the beneficiaries are immediately identifiable, while the costs are distributed among the many.  In this case, presumably, the beneficiaries are largely unseen, while everyone sees the hit to the bottom line.)

So, is there are good reason that insurance companies don’t do this?  Is it just that they haven’t thought of it, or is there actual evidence that it doesn’t work?  Is anyone aware of any results from the Anthem experiment that show one way or the other?