Despite broad agreement that the United States has insufficient primary care capacity, the health policy literature has devoted far more attention to how primary care should be paid for than to how states can develop and finance the additional capacity a high-functioning system requires. The shortage is evident at the most basic level: too many people cannot obtain timely access to primary care. But the problem extends beyond access. The United States also underperforms many peer nations in mortality, morbidity, and other measures of health system performance. The objective, therefore, is not merely to create enough capacity to see everyone who needs care. It is also to build the capacity required to deliver consistently high-quality, high-functioning primary care.
Increasing reimbursement and shifting a larger share of healthcare spending toward primary care are important policy objectives, particularly for sustaining the existing workforce and delivery system. But they do not determine what additional capacity must be built or provide the investment and development capability needed to create it. The Rural Health Transformation Program is an important recent exception, providing substantial resources and requiring integrated planning for rural healthcare systems. Its rural focus and restrictions on how the funds may be used leave the broader statewide challenge unresolved. States need an infrastructure development and investment strategy that identifies what must be built or improved, mobilizes the necessary capital and other funding, and assigns continuing responsibility for carrying the work forward.
For readers seeking a concrete financing model, the companion paper, State Primary Care Funding Strategy: An Infrastructure Investment Fund, describes one possible approach to organizing and financing this work.
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