Primary Care Spending as a Proportion of Total Spending for Children vs Adults

BACKGROUND: A crisis in primary care access for adults has led to calls to increase primary care spending to specific targets. It is unknown whether the same targets for primary care spending should be used in pediatrics since total and primary care spending patterns differ between adults and children. METHODS: We determined percent of total spending devoted to primary care and average expenditures, along with trends over 20 years, by payer type (commercial vs. Medicaid) and age group, using the Medical Expenditure Panel Survey. RESULTS: Primary care share averaged 8% during this period across all ages without significant change over time. Pediatrics (0-18 years) averaged 17.0%, partly reflecting lower total spending in pediatrics (fewer hospitalizations, expensive surgeries, and medications). Average expenditures ranged from $2,767 for 0-18 y.o. to $14,429 for elder adults. Primary care share was lower for children insured by Medicaid (11.7%), likely reflecting higher rates of chronic and complex conditions. Among all children, per capita primary care spend was $470, but varied from $276 for those on Medicaid to $494 for commercially-insured children. CONCLUSIONS: Lower total pediatric expenditures partly reflect less high-cost need, but also high rates of Medicaid coverage with low payment. Pediatric primary care will benefit from increasing primary care percent spend and improvements in financing pediatric care. As percent expenditure on primary care for children is already higher than for older populations, simply raising it to a specific target (e.g., 15%) will benefit pediatrics less than other strategies (e.g., doubling primary care spend).