Bringing Children Into the Primary Care Investment Debate

The work of pediatrician Barbara Starfield established that primary care is unique. Defined by first-contact access, continuity, comprehensiveness, and coordination-and delivered through enduring relationships with patients and families-primary care provides the essential foundation for any high-performing health care system. Yet the United States has persistently underinvested in that foundation, leaving primary care practices chronically under resourced.1 Recognizing this crisis for the overall population, states and national organizations are measuring primary care spending, setting explicit investment targets, and pressing to rebalance the health care dollar toward primary care. Although these approaches differ in payer scope, definitions, and enforcement, they share a central premise: within a constrained health care budget, greater investment in primary care must be intentional rather than left to market forces. One recent expression of this movement, the Triple Double campaign, calls for doubling primary care investment from 5% to 10% of health care spending, while also doubling its reach and the proportion of the next generation choosing primary care.2 In this issue of Pediatrics, Perrin et al ask an essential question that this movement has largely left unanswered: What should primary care investment policy mean for children?3.