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Health System Expansion

 
​​​​It is an understatement to say that health care today is being changed in many directions by many forces. This expansion of the health care system includes more people covered by health insurance, greater demand for primary care services, and the introduction of new delivery and payment systems.


Changes in Health Insurance Enrollment

All told, more than 30 million Americans now have insurance under various new sources of coverage and consumer protections. Since some previously had insurance, the numbers of uninsured persons declined from 16.4 million to an estimate 7 million. Although this is unprecedented, it will have a unique impact on the demand for health care.

Changes in Primary Care Workforce

Based on current utilization patterns, demand for primary care physicians is projected to grow more rapidly than physician supply.

  • The number of primary care physicians is projected to increase from 205,000 FTEs in 2010 to 220,800 FTEs in 2020 - an 8 percent increase.

  • The total demand for primary care physicians is projected to grow by 28,700, from 212,500 FTEs in 2010 to 241,200 FTEs in 2020 - a 14 percent increase.

  • Without changes to how primary care is delivered, the growth in primary care physician supply will not be adequate to meet demand in 2020, with a projected shortage of 20,400 physicians. While this deficit is not as large as has been found in prior studies, the projected shortage of primary care physicians is still significant.

Resource
Projecting the Supply and Demand for Primary Care Practitioners Through 2020​ from the Health Resources and Services Administration Bureau of Health Professions National Center for Health Workforce Analysis, 2013.

Changes in Health Care Delivery, Organization, and Payment

The Affordable Care Act (ACA) contains numerous provisions targeting how health care is organized, delivered, and paid for in the US. These provisions address recognized shortcomings of the U.S. health system, from the inefficiency and high cost of the predominantly fee-for-service system to the extreme variability in the quality of care patients receive. Taking multiple, complementary approaches to addressing these longstanding problems, the ACA centers on three central aims.

  • Testing new models of health care delivery – (eg, Accountable Care Organizations, Primary Care Transformation Through Implementation of Medical Homes, Comprehensive Primary Care Initiative, Multi-Payer Advanced Primary Care Practice Demonstration)

  • Shifting from a reimbursement system based on the volume of services provided to one based on the value of care.

  • Investing in resources for system-wide improvement – (eg, Center for Medicare and Medicaid Innovation, Patient-Centered Outcomes Research Institute, Medicare–Medicaid Coordination Office, National Strategy for Quality Improvement in Health Care, Prevention and Public Health Fund) Because many of these provisions are still in the early stages of implementation and testing, it is difficult, if not impossible, to assess their impact definitively. Some reports have attempted to do so and are very informative.

Resource
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