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• v.17(6); 2019 Nov

National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015

1 Icahn School of Medicine at Mount Sinai, New York City, New York

2 Harvard Medical School, Boston, Massachusetts

Kristin N. Ray

3 Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Ateev Mehrotra

4 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Ishani Ganguli

5 Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts

Recent evidence shows a national decline in primary care visit rates over the last decade. It is unclear how changes in practice—including the use and content of primary care visits—may have contributed.

We analyzed nationally representative data of adult visits to primary care physicians (PCPs) and physician practice characteristics from 2007–2016 (National Ambulatory Medical Care Survey). United States census estimates were used to calculate visits per capita. Measures included visit rates per person year; visit duration; number of medications, diagnoses, and preventive services per visit; percentage of visits with scheduled follow-up; and percentage of physicians with practice capabilities including an electronic medical record (EMR).

Our weighted sample represented 3.2 billion visits (83,368 visits, unweighted). Visits per capita declined by 20% (−0.25 visits per person, 95% CI, –0.32 to –0.19) during this time, while visit duration increased by 2.4 minutes per visit (95% CI, 1.1-3.8). Per visit, PCPs addressed 0.30 more diagnoses (95% CI, 0.16-0.43) and 0.82 more medications (95% CI, 0.59-1.1), and provided 0.24 more preventive services (95% CI, 0.12-0.36). Visits with scheduled PCP followup declined by 6.0% (95% CI, –12.4 to 0.46), while PCPs reporting use of EMR increased by 44.3% (95% CI, 39.1-49.5) and those reporting use of secure messaging increased by 60.9% (95% CI, 27.5-94.3).

From 2008 to 2015, primary care visits were longer, addressed more issues per visit, and were less likely to have scheduled follow-up for certain patients and conditions. Meanwhile, more PCPs offered non–face-to-face care. The decline in primary care visit rates may be explained in part by PCPs offering more comprehensive in-person visits and using more non–face-to-face care.

INTRODUCTION

Primary care is an essential component of a high-performing health care system. 1 Patients with access to a regular primary care physician (PCP) are more likely to receive recommended screenings, have fewer preventable hospital admissions, and experience lower mortality. 2 – 4

In kind, many US policy initiatives over the past decade have sought to bolster primary care use and access. For example, the Patient Protection and Affordable Care Act eliminated co-payments for recommended preventive services and introduced the Annual Wellness Visit for Medicare patients. 5 Yet, there is recent evidence of a 6%-25% decline in primary care visit rates over the past decade across commercial, Medicare, and nationally representative samples 6 – 8 and it is unclear why.

Among other mechanisms, the decline may be explained in part by changes in how physicians provide primary care both during and outside of in-person visits. 8 For example, aided by electronic health records, 9 , 10 PCPs may be able to address more issues during a given in-person visit. 11 , 12 With the encouragement of initiatives like the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) 13 and the patient centered medical home model, 14 PCPs may also provide more non–face-to-face care outside of those visits (eg, through secure messaging or virtual visits). 15 , 16 Yet, there is little evidence of how the use and content of primary care visits and physician practice capabilities have changed in this context over the past decade. 17

Understanding the potential contribution of primary care practice changes to a decline in visit rates may help policy makers and health care leaders make sense of and respond to this trend. Therefore, we assessed national trends in primary care visits and practice capabilities using 2007-2016 data from the National Ambulatory Medical Care Survey (NAMCS).

Data Sources

We used NAMCS data from January 1, 2007 to December 31, 2016. NAMCS is a nationally representative survey conducted annually by the National Center for Health Statistics (NCHS) to examine patient visits to physicians in non–federally funded, non–hospital-based offices.

Through a standardized form completed by a physician or an outside coder using the medical record, NAMCS collects visit-level data on patient demographic information and clinical details, such as the main visit diagnoses, services provided, and visit disposition. NAMCS also collects physician and practice-level data through a physician induction survey.

NAMCS uses a 3-stage stratified sampling design that allows for calculation of national estimates at the visit and physician level. The first stage sample includes 112 primary sampling units consisting of geographic segments (eg, counties and towns) within the United States. The second stage sample consists of practicing physicians selected from the American Medical Association Masterfile. Lastly, for each physician practice selected, visits are sampled during a randomly selected 1-week period.

We obtained 2007-2016 data on the total US population as well as the age, sex, race, insurance status, and setting of US adults from the Current Population Survey (CPS).

Study Sample

We examined ambulatory visits to physicians by patients aged ≥18 years. We identified primary care visits as those performed by a physician with a self-reported specialty of internal medicine, pediatrics, or family medicine. We excluded community health center visits to allow for consistency across the study period as recommended by the NCHS.

For each visit, we described patient characteristics (age, sex, race, insurance status, setting) and the primary visit diagnosis or patient reason for visit (Supplemental Tables 1 and 2, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1 ). To further examine visit content, we determined the number of visit diagnoses (up to 3 listed International Classification of Diseases, Ninth Revision [ICD-9]/International Classification of Diseases, Tenth Revision [ICD-10] codes), medications (up to 8 per visit), preventive services (up to 9 per visit out of the following services included in NAMCS 2007-2016: cholesterol, hemoglobin A 1c , mammogram, depression screening, colonoscopy referral, bone-density, vaccines, chlamydia screening, and Papanicolaou smear), and procedures (up to 4 per visit out of the following 8 procedures commonly performed by PCPs: ultrasound, wound care, skin excision, infusion, biopsy, irrigation, joint care, cerumen removal) (Supplemental Table 3, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1 ). We also assessed visit duration (physician-reported time directly spent with each patient), and whether the visit was associated with scheduled follow-up. To assess PCP use of non–face-to-face and after-hours care, we examined the following physician-level capabilities that were consistently included in the survey instrument during the study period: electronic medical record (EMR), e-mail consultation, electronic messaging (data available 2011-2015), telephone consultation, and after-hours appointments.

We calculated visits per capita by dividing the number of visits by the annual CPS population estimate overall and for each demographic subgroup. We also calculated per capita visit rates by their primary visit diagnosis groups. In each year, we estimated mean visit duration and mean number of diagnoses, medications, preventive services, and procedures per visit.

In a sensitivity analysis to address the possibility that changes in the number of diagnoses and medications addressed per visit may be confounded by the adoption of electronic medical records, we stratified trends in diagnoses and medications per visit by practice EMR capability. We examined trends in visits with scheduled in-person PCP follow-up over time by estimating the percentage of visits each year with a scheduled follow-up overall and by patient characteristics and visit diagnosis groups. To identify trends in practice capabilities, we used physician-level weights to estimate the percentage of physicians who reported having a given practice capability in each year.

We used 3-year rolling averages to minimize yearly fluctuations (eg, 2008 estimate included 2007-2009 data) throughout the analysis. We tested for trends over time using either survey-weighted linear regressions (continuous variables) or linear proportion models (dichotomous variables) with year (grouped into 3-year rolling averages) as a continuous independent variable and presented results as the change across 8 years. In accordance with NCHS standards, we excluded estimates with fewer than 30 unweighted cases per cell. 18 We used Stata version 14.1 (Stata-Corp LLC) to perform all analyses. This study of de-identified survey data was exempt from review based on 45CFR46.102.

Over the 8-year period, our weighted sample represented 3.2 billion primary care visits. The number of primary care visits decreased from 336 million to 299 million per year. Per capita visit rates declined from 1.5 visits per person in 2008 to 1.2 visits per person in 2015: a 20% decline over the study period (−0.25 visits per person, 95% CI, –0.32 to –0.19) ( Table 1 ).

Annual Rate of Primary Care Visits Per Person by Patient Characteristics, 2008-2015 a

NACMS =National Ambulatory Medical Care Survey.

Changes in Per Capita Visit Rates by Patient Demographics and Type of Visit

We observed declines within demographic subgroups of sex, age, race, insurance type, and setting ( Table 1 ). The decline was largest among adults aged ≥65 years (−0.68 visits per person, 95% CI, –0.87 to –0.49), white adults (−0.57 visits per person, 95% CI, –0.81 to –0.33), and those in rural areas (−0.48 visits per person, 95% CI, –0.86 to –0.10).

We saw declines in rates of visits for primary diagnoses including upper respiratory tract infections, urinary tract infections, joint pain, back pain, headache, and hypertension, as well as for visits to discuss lab results ( Figure 1 ). In contrast, rates of general medical exams increased (+0.05 visits per person, 95% CI, 0.03-0.07), as did visits for mental illness (+0.005 visits per person, 95% CI, 0.001-0.01).

Percent change in per capita visit rates by main visit diagnosis from 2008-2015 .

NACMS = National Ambulatory Medical Care Survey.

Visits per capita calculated by dividing NAMCS visits for each diagnosis by Current Population Survey total population estimate. Eight-year trend calculated for each subgroup by multiplying per year regression coefficient across study period. Changes were significant at P <.05 for all diagnoses except type 2 diabetes and allergic rhinitis.

Visit Characteristics

The duration of primary care visits increased by 2.4 minutes per visit (95% CI, 1.1-3.8) over the 8-year period ( Table 2 ). On average during these visits, PCPs addressed more diagnoses (+0.30 diagnoses per visit, 95% CI, 0.16-0.43) and medications (+0.82 medications per visit, 95% CI, 0.59-1.1). PCPs also provided more preventive services (+0.24 services per visit, 95% CI, 0.12-0.36; Table 2 , Supplemental Table 4, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1 ) and procedures (+0.02 procedures per visit, 95% CI, 0.01 to −0.03; Table 2 , Supplemental Table 5, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1 ). In a sensitivity analysis, we observed similar trends in the diagnoses and medications addressed per visit among PCPs with and without EMR capability (Supplemental Table 6, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1 ).

Visit Characteristics Per Primary Care Visit, 2008-2015

Visits With Scheduled Follow-Up

The percentage of visits with scheduled PCP follow-up declined from 62% to 57% (−6.0%, 95% CI, –12.4 to 0.46; Table 3 ). This decline was largest and statistically significant among patients aged ≥65 years (−10.4%, 95% CI, –15.5 to –5.2) and across patients with 1 to 5 chronic conditions, but not among younger patients or patients without a chronic condition. When examining follow-up by visit diagnosis groups, significant declines in follow-up occurred among visits addressing specific chronic illnesses and for visits to evaluate back pain, but not for visits addressing other acute conditions.

Percentage of Primary Care Visits With Scheduled Follow-Up by Patient Characteristics and Visit Type, 2008-2015

Practice Capabilities

During the study period, a rising share of PCPs reported using EMRs (+44.3%, 95% CI, 39.1-49.5) and offering e-mail consults (+9.6%, 95% CI, 6.1-13.3), secure messaging (+60.9%, 95% CI, 27.5-94.3), and after-hours appointments (+8.6%, 95% CI, 6.2-11.1). We found a decline in the percentage of PCPs reporting use of telephone consults (-9.7%, 95% CI, –13.4 to –6.2; Figure 2 ).

Change in the percentage of primary care physicians (PCPs) reporting practice capabilities.

EMR = electronic medical record.

Percentage of PCPs reporting practice capabilities, 2008 vs 2015 (EMR, e-mail consult, telephone consult, after-hours appointments) and 2011 vs 2015 (secure messaging).

We found a substantial decline in per capita PCP visit rates that persisted among most demographic subgroups. During this period, mean visit duration increased and PCPs addressed more issues per visit. PCPs were also more likely to report using non–face-to-face care, such as e-mail and secure messaging, and were less likely to schedule in-person primary care follow-up for some patients and conditions.

Our findings support an optimistic interpretation that the decline in primary care visits per capita may be driven in part by 2 key improvements in primary care practice. First, PCPs may be providing more comprehensive care per visit, contributing to less need for in-person follow-up. PCPs conducted longer visits and addressed more medications, diagnoses, and services such as vaccines and wound care that require in-person administration. 19 , 20 Second, PCPs may be using more non–face-to-face care to address issues outside of in-person visits–especially given sharp declines in visit rates for lab results and low acuity issues (eg, urinary tract infection, upper respiratory infection) that may be better addressed through non–face-to-face or self-care. 21 – 23 Visit rates for hypertension also declined, as did the percentage of hypertension visits with scheduled in-person follow-up, which may suggest a shift towards the virtual management of chronic illness. 24

The primary care practice changes we highlight may be driven by both physician and patient factors. PCPs may selectively manage certain chronic and low-acuity issues through non–face-to-face care to create more time for patients who need in-person visits. 25 PCPs may leverage growing EMR functionality to get more done during face-to-face visits: for example, providing a needed routine vaccination flagged by the EMR during an acute care visit. 26 Another possibility is that patients are asking their PCPs to address more issues per visit and opting for non–face-to-face care to minimize the rising out-of-pocket costs and opportunity costs of in-person visits. 27 – 29 Lastly, patients may feel a reduced need for scheduled follow-up, as more primary care offices incorporate same-day appointment scheduling. 30

We note that the primary care visit decline may also reflect trends such as rising financial barriers and use of alternative venues. With the rise of high-deductible health plans, some may be unwilling or unable to pay out-of-pocket costs for primary care visits. 31 To this end, PCPs may be billing more visits as “preventive” to reduce costs for their patients, as the Patient Protection and Affordable Care Act requires Medicare and most private plans to cover this visit type. 5 For certain acute issues, adults may forego a visit to their PCP, instead choosing an urgent care or retail clinic that offers a more timely or convenient option. 32 , 33 The rise of office-based primary care visits by nurse practitioners and physician assistants– which NAMCS data do not capture–may also account for a small portion of the decline. 7 , 34 Ultimately, to understand whether this decline in visits per capita represents a positive or negative change, future work is needed to quantify how the decline affects patient outcomes.

There are several limitations to our study. First, NAMCS relies on physician self-report. However, NAMCS data, including visit duration and tests provided, have been validated in previous work. 35 , 36 Second, NAMCS may underestimate visit complexity as physicians can only include 3 diagnoses and 8 medications with a given visit, while prior studies in primary care settings suggest that physicians regularly address more than 3 medical issues per visit. 37 However, this ceiling effect would bias our result to the null, whereas we found a significant increase in diagnoses and medications per visit. Third, it is possible that our findings may be affected by changes in documentation and billing practices that may in turn contribute to a rise in physician or coder-reported diagnoses; however, our findings persisted in analyses stratified by PCP EMR status. Finally, we acknowledge that we did not directly assess other mechanisms for the decline such as unmet need due to access barriers, 8 the role of nurse practitioners and physician assistants, nor how the decline affects quality of care or patient outcomes, as NAMCS visit-level data does not allow for this type of analysis.

To the degree that the decline in PCP visits per capita represents better use of office visits and non– face-to-face care, rather than unmet need, the trends we find align with the goals of new delivery models such as the patient-centered medical home and the recent Centers for Medicare and Medicaid Services Primary Care Initiative. 14 , 38 In addition, our findings suggest the need to recognize and remunerate PCPs adequately for increasingly complex work, and mitigate the potential for PCP burnout, through strategies such as adequate reimbursement for non–visit-based care and further support of these delivery models. 39

Conflicts of interest: Dr Ganguli reports receiving compensation as a consultant from Haven. The authors have no other conflicts of interest to disclose.

To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/6/538 .

Supplemental materials: Available at http://www.AnnFamMed.org/content/17/6/538/suppl/DC1/ .

Table 6: Average Number of Family Physician Patient Encounters Per Week by Setting

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

• Introduction
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Dotted lines denote the mean visit length for the 25th percentile, 50th percentile (median), and 75th percentile primary care physician.

Coefficients and 95% CIs were from a multivariable model including physician fixed effects and all patient or visit characteristics. Markers indicate the change in mean visit length associated with each patient or visit characteristic compared with the reference category, and whiskers indicate 95% CIs, which are too small to see due to the large sample size. eTable 3 in Supplement 1 shows a bivariate model regressing visit length by each characteristic individually. Other race and ethnicity includes American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander. Chronic condition count was based on the number of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes and a 1-year look-back period. Visit diagnosis count was calculated as the number of ICD-10 diagnosis codes billed during the visit. FFS indicates fee for service.

Adjusted binned scatterplots and linear fit lines used ordinary least squares (OLS) regression. Dots indicate the mean y-value for equal-sized bins of x-values, controlling for patient and visit characteristics and including physician fixed effects. The following regression coefficients and 95% CIs were derived from the identical multivariable OLS model treating visit length as a continuous variable and including physician fixed effects and all patient or visit characteristics: A, −0.11 percentage points (95% CI, −0.14 to −0.09 percentage points); B, −0.01 percentage points (95% CI, −0.01 to −0.009 percentage points); and C, 0.004 percentage points (95% CI, 0.003-0.006 percentage points). C, Based on the Beers criteria. 27

eFigure 1. Sample Selection Diagram

eTable 1.  ICD-10 Diagnoses Used to Define Subsamples Relevant to Potentially Inappropriate Prescribing Outcomes

eTable 2. Patient and Appointment Characteristics, Within the athenahealth Sample and the National Ambulatory Medical Care Survey (NAMCS)

eTable 3. Bivariate and Multivariate Exam Length Regression Results

eFigure 2. Association of Opioid and Benzodiazepine Coprescribing With Visit Length, in Visits With a Painful Condition and Anxiety Diagnosis, 2017

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Neprash HT , Mulcahy JF , Cross DA , Gaugler JE , Golberstein E , Ganguli I. Association of Primary Care Visit Length With Potentially Inappropriate Prescribing. JAMA Health Forum. 2023;4(3):e230052. doi:10.1001/jamahealthforum.2023.0052

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Association of Primary Care Visit Length With Potentially Inappropriate Prescribing

• 1 Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
• 2 Harvard Medical School, Boston, Massachusetts
• 3 Brigham and Women’s Hospital, Boston, Massachusetts

Question   Are primary care physicians more likely to prescribe potentially inappropriate medications during shorter visits?

Findings   In this cross-sectional study of 4 360 445 patients, those who were younger, publicly insured, Hispanic, or non-Hispanic Black had shorter primary care physician visits. Shorter visits were associated with a higher likelihood of inappropriate antibiotic prescribing for patients with upper respiratory tract infections and coprescribing of opioids and benzodiazepines for patients with painful conditions.

Meaning   In this study, shorter primary care visits were associated with some, but not all, measures of inappropriate prescribing.

Importance   Time is a valuable resource in primary care, and physicians and patients consistently raise concerns about inadequate time during visits. However, there is little evidence on whether shorter visits translate into lower-quality care.

Objective   To investigate variations in primary care visit length and quantify the association between visit length and potentially inappropriate prescribing decisions by primary care physicians.

Design, Setting, and Participants   This cross-sectional study used data from electronic health record systems in primary care offices across the US to analyze adult primary care visits occurring in calendar year 2017. Analysis was conducted from March 2022 through January 2023.

Main Outcomes and Measures   Regression analyses quantified the association between patient visit characteristics and visit length (measured using time stamp data) and the association between visit length and potentially inappropriate prescribing decisions, including inappropriate antibiotic prescriptions for upper respiratory tract infections, coprescribing of opioids and benzodiazepines for painful conditions, and prescriptions that were potentially inappropriate for older adults (based on the Beers criteria). All rates were estimated using physician fixed effects and were adjusted for patient and visit characteristics.

Results   This study included 8 119 161 primary care visits by 4 360 445 patients (56.6% women) with 8091 primary care physicians; 7.7% of patients were Hispanic, 10.4% were non-Hispanic Black, 68.2% were non-Hispanic White, 5.5% were other race and ethnicity, and 8.3% had missing race and ethnicity. Longer visits were more complex (ie, more diagnoses recorded and/or more chronic conditions coded). After controlling for scheduled visit duration and measures of visit complexity, younger, publicly insured, Hispanic, and non-Hispanic Black patients had shorter visits. For each additional minute of visit length, the likelihood that a visit resulted in an inappropriate antibiotic prescription changed by −0.11 percentage points (95% CI, −0.14 to −0.09 percentage points) and the likelihood of opioid and benzodiazepine coprescribing changed by −0.01 percentage points (95% CI, −0.01 to −0.009 percentage points). Visit length had a positive association with potentially inappropriate prescribing among older adults (0.004 percentage points; 95% CI, 0.003-0.006 percentage points).

Conclusions and Relevance   In this cross-sectional study, shorter visit length was associated with a higher likelihood of inappropriate antibiotic prescribing for patients with upper respiratory tract infections and coprescribing of opioids and benzodiazepines for patients with painful conditions. These findings suggest opportunities for additional research and operational improvements to visit scheduling and quality of prescribing decisions in primary care.

Time is a scarce and valuable resource in primary care, with the average visit lasting 18 minutes. 1 By a recent estimate, primary care clinicians would require 27 hours per day to provide all guideline-recommended preventive, chronic disease, and acute care to a typical patient panel. 2 While there is global variation in primary care visit length, 3 recent growth in visit content (eg, diagnoses recorded and medications prescribed) has outpaced growth in visit length, 4 , 5 suggesting that time available per health concern may be decreasing over time. 6 In surveys, patients routinely report needing more time with their primary care physician, 7 , 8 and visit length is one of the most prominent factors associated with patients’ satisfaction with their care. 9 , 10 Physicians also want more time with their patients and frequently report feeling rushed during visits. 11 - 13

It is widely believed that shorter visits are associated with lower-quality care for patients. 14 , 15 In particular, there is concern that clinicians make less-appropriate prescribing decisions in shorter visits since it takes time to make diagnoses, discuss existing treatment regimens, identify potential medication conflicts, and deprescribe as necessary. 16 Clinicians may view some prescriptions (eg, opioids, antibiotics) as quick fixes when discussion of alternatives (eg, physical therapy, watchful waiting) would take additional time and effort or as a strategy to resolve a tense patient interaction. 17 - 19

Yet, evidence on the association between visit duration and quality of care is limited and mixed. One study using national survey data found that providing recommended counseling or screening required additional time, but appropriate medication prescribing for chronic conditions was not associated with visit duration. 20 Another study using the same national survey data found that upper respiratory tract infection visits that included an antibiotic prescription were shorter than visits without an antibiotic prescription. 21 Other research using direct observation techniques found more complete discussion of new prescription medications during longer visits. 22 Finally, some studies have documented an association between time pressure and the provision of likely low-value prescribing but not for all outcomes studied. 23 , 24 To our knowledge, none of these studies accounted for known practice differences between clinicians in their baseline propensity for visit length and prescribing decisions.

Using a multistate sample of electronic health record (EHR) data, we first examined patient clinical and sociodemographic characteristics associated with visit length. Controlling for these characteristics, we then examined within-physician changes in potentially inappropriate prescribing decisions, including inappropriate antibiotic prescribing, coprescribing opioids and benzodiazepines, and potentially inappropriate prescribing for older adults as a function of primary care visit duration. Results from these analyses may inform policy makers and health system leaders as they balance visit volume pressures and the need to deliver high-quality care.

Because only deidentified administrative data were used, this cross-sectional study was deemed not to be research involving human participants and therefore was exempt from informed consent requirements and institutional review board review by the institutional review board at the University of Minnesota. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.

We used a subset of claims and EHR data from athenahealth Inc, a cloud-based health care information technology company that provides physician practices with medical billing, practice management, and EHR services. These data have been used in prior work related to visit length measurement and prescribing behavior. 1 , 24 , 25

The study sample included visits for adult patients seeing primary care physicians (defined as those with internal medicine, family practice, and general practice specialties) across the US who used the full suite of athenahealth services (ie, billing management and EHR) in calendar year 2017. Using previously validated methods, 1 , 25 we excluded visits without reliable measures of observed duration (eFigure 1 in Supplement 1 gives additional detail on sample construction). We used visit subsamples to assess specific prescribing outcomes: visits with a diagnosis of upper respiratory tract infection (for the inappropriate antibiotic prescribing outcome), visits with a pain-related diagnosis (for the coprescribing of opioids and benzodiazepines outcome), and visits for adults aged 65 years or older (for the potentially inappropriate prescribing among older adults outcome) (the Table gives patient and visit characteristics of each sample, and eTable 1 in Supplement 1 gives a list of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ ICD-10 ] diagnosis codes and medications used to define subsamples).

We measured visit length using time stamps, which document clinicians’ actions in the EHR across stages of a patient encounter from check-in and intake through face-to-face encounter, checkout, and signoff. Typically, once staff members have completed check-in (eg, confirming insurance coverage), a medical assistant conducts the intake assessment (eg, vital signs and medication reconciliation). Following intake, the physician clicks “Go to Exam” to start the visit (eg, taking patient history, performing a physical examination, and placing orders). At the end of the visit, the physician closes the examination stage to advance the encounter to the checkout stage. To measure visit length, we used previously published methods of processing time stamps recorded during the face-to-face examination stage of each primary care visit, which encompasses the interaction between patient and physician. 1 , 25

We examined 3 outcomes representing inappropriate or potentially inappropriate prescribing decisions: inappropriate antibiotics for upper respiratory tract infections, coprescribing of opioids and benzodiazepines, and potentially inappropriate prescribing for older adults. For inappropriate antibiotic prescribing, we implemented a widely used definition relying on the presence of an antibiotic prescription linked by exact patient identifier, physician identifier, and date to a visit with a primary diagnosis of upper respiratory tract infection. 26 Similarly, we defined opioid and benzodiazepine coprescribing as a visit with a pain-related primary diagnosis and both an opioid and a benzodiazepine prescription linked to the visit. 24 As a sensitivity analysis, we repeated this prescribing outcome among visits with both a pain-related primary diagnosis and an anxiety diagnosis. Finally, we identified all visits for adults aged 65 or older that were linked to prescriptions for medications listed by the 2019 updated Beers criteria 27 (ie, a consensus statement from the American Geriatrics Society on potentially inappropriate medications for older adults) as having a strong recommendation of avoid based on high-quality evidence. If a prescription was linked to the visit, this meant that the prescription was newly ordered, refilled, or confirmed at the visit. As with past work, 24 we linked prescriptions to visits by exact patient identifier, physician identifier, and date.

We used submitted insurance claims and structured EHR data based on patient self-report to collect visit-level data on patients’ age, sex, marital status, race and ethnicity (collected via patient self-report by medical practices; Hispanic, non-Hispanic Black, non-Hispanic White, other [American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander], and missing), primary insurer (ie, commercial, dual eligible [for Medicare and Medicaid], Medicare Advantage, Medicare fee-for-service, Medicaid, other payer, or uninsured), visit type (ie, new or established), scheduled visit duration (10, 15, 20, or 30 minutes), diagnosis count (number of ICD-10 diagnosis codes billed during the visit, a proxy for number of topics discussed), and chronic condition count. We used ICD-10 codes and a 1-year look-back period to replicate widely used algorithms for 27 possible chronic condition categories. 28

Data were analyzed from March 2022 through January 2023. For each primary care physician included in the sample, we calculated their mean visit length and plotted a histogram ( Figure 1 ) showing the proportion of physicians by the mean visit length. We used bivariate analyses to assess the association between patient and visit characteristics and visit length and then constructed a multivariable linear probability model with visit length as the outcome that included these characteristics. We then built a multivariable linear probability model to assess the association of visit length with potentially inappropriate prescribing, controlling for patient and visit characteristics. All models also included physician fixed effects to control for time-invariant differences across physicians in visit length and prescribing patterns. As such, results can be interpreted as comparisons of prescribing outcomes as a function of each individual physician’s variation in visit length. All inappropriate prescribing models were limited to visits with a length of 5 minutes or longer to exclude visits in which patient conditions may not have been discussed (eg, visits solely for prescription refills). All regression analyses used Huber-White robust SEs to assess statistical significance, which was defined as 2-sided P  < .05. Analyses were conducted using Stata, version 16 (StataCorp LLC). To display adjusted regression results graphically, we used the binscatter command in Stata, which creates a binned scatterplot (ie, a nonparametric method of quantifying the mean y-value for equal-sized bins of x-values, controlling for patient and visit characteristics and including physician fixed effects).

The study sample consisted of 8 119 161 visits for 4 360 445 patients (43.4% men and 56.6% women) seeing 8091 primary care physicians in 4597 practices. Of the total visits, 7.7% were for Hispanic patients, 10.4% for non-Hispanic Black patients, 68.2% for non-Hispanic White patients, 5.5% for patients with other race and ethnicity, and 8.3% for patients with missing race and ethnicity ( Table ). Compared with a national sample of 8906 patients with office-based primary care visits from the National Ambulatory Medical Care Survey (NAMCS), patients receiving visits in the study sample were less likely to be non-Hispanic White (75.1% vs 68.2%), more likely to have commercial insurance (44.1% vs 48.5%) and Medicare (34.9% vs 40.2%), less likely to have Medicaid (8.3% vs 7.7%) or be uninsured (4.9% vs 2.6%), and more likely to have no chronic conditions (34.1% vs 41.5%) (eTable 2 in Supplement 1 ). Comparing the NAMCS sample with the athenahealth sample, we found similar rates of 1 chronic condition (24.5% vs 24.4%) and 2 chronic conditions (16.8% vs 16.4%), a similar sex distribution of visits, and a similar age distribution of visits (eTable 2 in Supplement 1 ). Compared with the NAMCS, the athenahealth sample somewhat overrepresented visits in the South (43.9% vs 54.9%) and underrepresented visits in the West (21.8% vs 8.6%), with similar proportions of visits in the Northeast (17.6% vs 17.7%) and Midwest (16.8% vs 18.7%). Patient and visit characteristics varied across the 3 subsamples used for our 3 potentially inappropriate prescribing measures ( Table ).

Visit duration varied considerably between and within primary care physicians. The median physician in the sample spent a mean of 18.9 minutes with each patient ( Figure 1 ). Physicians in the top quartile of visit length spent a mean of 24.6 minutes or longer with their patients, while physicians in the bottom quartile of visit length spent a mean of 14.1 minutes or less with their patients.

When examining within-physician variation in visit length, we found that visit length was significantly associated with nearly every patient and visit characteristic ( Figure 2 and eTable 3 in Supplement 1 ). Compared with a 10-minute scheduled visit, visits scheduled for 30 minutes received 4.0 additional minutes (95% CI, 3.9-4.1 minutes). Compared with visits with only 1 recorded diagnosis, visits with 5 or more diagnoses were 9.1 minutes (95% CI, 9.1-9.2 minutes) longer. Compared with visits for established patients, visits for new patients were 4.1 minutes (95% CI, 4.1-4.2 minutes) longer. Visit length was also slightly longer for female patients compared with male patients (female: 17.2 minutes [95% CI, 17.2-17.2 minutes]; male: 17.0 minutes [95% CI, 16.9-17.0 minutes]), patients aged 65 years or older compared with the youngest age groups (eg, ≥65 years: 17.2 minutes [95% CI, 17.1-17.2 minutes]; 25-44 years: 16.8 minutes [95% CI, 16.8-16.8 minutes]), non-Hispanic White patients compared with Hispanic and non-Hispanic Black patients and patients from other race and ethnicity (non-Hispanic White: 17.2 minutes [95% CI, 17.2-17.2 minutes]; Hispanic: 16.8 minutes [95% CI, 16.7-16.8 minutes]; non-Hispanic Black: 16.7 minutes [95% CI, 16.6-16.7 minutes]; and other: 16.9 minutes [95% CI, 16.9-17.0 minutes]), and patients with commercial insurance compared with all other types of insurance (eg, commercial: 17.2 minutes [95% CI, 17.2-17.2 minutes]; Medicaid: 16.7 minutes [95% CI, 16.7-16.8 minutes]).

Within the study sample, 55.7% of 222 667 visits for upper respiratory tract infection involved an inappropriate antibiotic prescription, 3.4% of 1 571 935 visits for painful conditions involved coprescribing opioids and benzodiazepines, and 1.1% of 2 756 365 visits for adults aged 65 years or older involved the prescription of medications contraindicated by the Beers criteria. After adjusting for all patient covariates, the likelihood that an upper respiratory tract infection visit included an inappropriate antibiotic prescription decreased as visit length increased ( Figure 3 ). For every additional minute of visit length, the likelihood of inappropriate antibiotic prescribing changed by −0.11 percentage points (95% CI, −0.14 to −0.09 percentage points) and the likelihood of opioid and benzodiazepine coprescribing changed by −0.01 percentage points (95% CI, −0.01 to −0.009 percentage points). In a sensitivity analysis limiting the sample of painful condition visits to those that also had an anxiety diagnosis, the likelihood of opioid and benzodiazepine coprescribing changed by −0.05 percentage points (95% CI, −0.07 to −0.04 percentage points) for every additional minute (eFigure 2 in Supplement 1 ). Potentially inappropriate prescribing among older adults increased slightly as a function of visit length (0.004 percentage points; 95% CI, 0.003-0.006 percentage points).

In a large, multistate sample of primary care visits, we found an association between visit length and some potentially inappropriate prescribing measures. When controlling for differences in physician practice style and patient and visit characteristics, longer visits were less likely to include an inappropriate prescription for an antibiotic and slightly less likely to include coprescribing of opioids and benzodiazepines. However, there was a positive association between visit length and prescribing a collection of potentially inappropriate medications for older adults that was unlikely to be clinically meaningful. This pattern of findings may reflect that inappropriate antibiotic prescribing would likely occur during acute care visits focusing on upper respiratory tract infection symptoms for which any additional time in the visit would likely be devoted to that single issue. In contrast, the other potentially inappropriate prescribing outcomes that we assessed are not specific to an acute condition (eg, coprescribing may occur for both acute and chronic pain) and therefore may occur in visits covering a range of patient concerns for which any additional time during the visit would not necessarily be allocated to the problem relevant to the potentially inappropriate prescribing outcome. For coprescribing and older adult outcomes, many of the prescriptions that we observed may have been refills; thus, it may have taken the physician less time to refill the medication than to engage in a discussion about deprescribing.

Given that shorter visit length was associated with some risk of lower-quality care, we were particularly interested in patient and visit characteristics that were associated with time spent with the physician. Many of these associations suggest that patients with more medical complexity or with more to discuss received more time with their physicians, which may be expected. For example, visits that included more diagnoses—an imperfect proxy for number of topics discussed—were longer, as were visits for patients with more previously recorded chronic conditions and for new patients. Interestingly, while visits with longer scheduled durations had longer observed durations, this was not a 1-to-1 association; visits scheduled for 30 minutes were only 4 minutes longer than those scheduled for 10 minutes, which tended to run longer than their scheduled time. This finding suggests that scheduled visit times do not necessarily represent clinical workflows accurately and points to the challenges that primary care physicians may face in adhering to scheduled visit times to care for a wide range of patients with diverse needs.

We also have particular concerns about the associations we found between patient-visit characteristics and visit length that were not easily explained by differences in perceived patient clinical need. For example, patients with Medicaid insurance coverage, dual Medicare and Medicaid coverage, or no insurance coverage received significantly shorter visits than commercially insured patients despite the latter population being healthier on average. Similarly, non-Hispanic Black patients received visits that were shorter, on average, than non-Hispanic White patients seeing the same physician. These visit-level differences may accumulate over time, potentially contributing to racial disparities in how much time patients spend with their physicians each year. 29 Our analyses cannot explain why these differences exist but should motivate organizations and policy makers to detect, interrogate, and address underlying systemic causes such as structural racism. 30

Our analyses highlight the fundamental tension between the volume incentives embedded in fee-for-service reimbursement systems and quality of care. 25 , 31 - 33 While our results do not suggest an optimal visit length, they do suggest that physicians’ time is not always allocated based on patient complexity. 34 Such findings suggest opportunities for a more equitable distribution. While risk adjusting visit length to match individual patients’ needs may be prohibitively complex from a logistical standpoint, practice leads could consider building in more flexibility than typically exists now. For example, practices could allow for 2 different visit lengths for problem-based visits, enabling physicians to indicate in advance which patients would benefit from the longer visit.

In particular, policy makers and health system leaders wishing to advance antibiotic stewardship best practices should take note of the association between visit length and inappropriate antibiotic prescribing. Our findings suggest that lengthening upper respiratory tract infection visits may be a promising strategy to lower inappropriate antibiotic prescribing, which has been a persistent population health concern for decades. However, meaningful gains in improved patient care quality and safety require that increases in visit time be accompanied by other thoughtful implementation strategies (eg, decision supports and shared decision-making tools) that promote consistency in value-based decision-making.

This study has several limitations. First, the results of this study should not be interpreted causally, although we were able to improve on existing studies of associations by comparing within-physician (rather than across-physician) variation in visit length and associated prescribing outcomes. There could still be unobserved reasons (eg, different communication styles, language barriers) for why patients were less likely to receive inappropriate antibiotic prescriptions during longer visits. Second, the cross-sectional nature of our data mean that we were unable to examine changes over time in prescribing patterns. Third, we relied on data from a convenience sample of primary care physicians who chose to purchase the services of athenahealth, and therefore our results may not generalize to all primary care physicians in the US. However, in many respects, primary care physicians within the athenahealth network appear to resemble primary care physicians in the US. Fourth, the samples that relied on diagnosis codes (ie, inappropriate antibiotic prescribing) likely changed with visit length since physicians may code themselves out of inappropriate antibiotic prescribing by recording different diagnoses during longer visits. Relatedly, visit length and diagnosis codes are an imperfect proxy for what was discussed by patients and physicians during the encounter. Fifth, our measure of opioid-benzodiazepine coprescribing was likely an underestimate since we defined it as coprescribing within the same visit. Patients may have an active opioid prescription when they receive a benzodiazepine prescription and vice versa. Sixth and relatedly, the potentially inappropriate prescribing decisions that we captured represent a small subset of the overall quality of care provided by a physician. Notably, we were unable to examine physician decisions indicative of high-quality (rather than low-quality) care, nor did we examine other facets of primary care quality such as referral decisions or diagnostic accuracy, which may also be associated with visit length.

In this cross-sectional study of primary care physician visit length, shorter visit length was associated with higher rates of inappropriate antibiotic prescribing for upper respiratory tract infections and inappropriate coprescribing of opioids and benzodiazepines for patients with painful conditions, but similar patterns were not found for other potentially inappropriate prescribing decisions. We found considerable within-physician variation in visit length, with younger, publicly insured, Hispanic, and non-Hispanic Black patients receiving shorter visits. These findings suggest opportunities for additional research and operational improvements to visit scheduling and quality of prescribing decisions in primary care.

Accepted for Publication: January 12, 2023.

Published: March 10, 2023. doi:10.1001/jamahealthforum.2023.0052

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Neprash HT et al. JAMA Health Forum .

Corresponding Author: Hannah T. Neprash, PhD, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455 ( [email protected] ).

Author Contributions: Dr Neprash and Mr Mulcahy had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Neprash, Gaugler, Ganguli.

Acquisition, analysis, or interpretation of data: Neprash, Mulcahy, Cross, Golberstein, Ganguli.

Drafting of the manuscript: Neprash.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Neprash, Mulcahy, Golberstein.

Obtained funding: Neprash.

Administrative, technical, or material support: Neprash, Cross, Gaugler.

Supervision: Neprash, Gaugler, Ganguli.

Conflict of Interest Disclosures: Dr Ganguli reported receiving grants from the National Institute for Health Care Management during the conduct of the study and receiving personal fees from F-Prime and grants from Arnold Ventures and the Agency for Healthcare Research and Quality outside the submitted work. No other disclosures were reported.

Funding/Support: This research was supported by pilot grant P30AG066613 from the University of Minnesota Life Course Center, which receives funding from the National Institute on Aging (NIA) (Dr Neprash). Dr Ganguli was supported in part by grant K23AG068240 from the National Institute on Aging.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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Frequency of visits to the doctors for a check-up among U.S. adults 2017, by age

Number of times adults in the u.s. went to the doctor for a check-up in the past year as of 2017, by age.

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Original question:[for check-ups:] How often did you visit a doctor during the past twelve months? Leave the field blank if you prefer not to answer.

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How Much Time Does A Doctor Visit Really Take?

July 4, 2022

First Stop Health

When you or a family member is not feeling well or hurt, finding quick care can be challenging. Doctor’s offices, urgent care centers and emergency rooms are three traditional options for care that are not time-friendly or convenient. Whether it’s travel time, transportation, taking time off work, cost or arranging for childcare, there are many personal factors to consider when seeking care at these institutions.

Transportation is one of the biggest barriers to accessing healthcare. 1 In fact, “Americans spend an average of 34 minutes on the road to a doctor’s office or other medical entity,” totaling more than an hour of travel time to and from an in-person visit. 2 This statistic excludes the time it takes with public transportation. Shockingly, 45% of Americans do not have access to public transportation and 3.6 million people do not get care annually due to limited transportation access. 3, 4  

Another personal factor to consider is childcare. The average cost for childcare is $15 and $23 per hour and accessing childcare may not be easy. 5 Due to COVID-19, childcare centers across the U.S. are in short supply. 6  

Now that we’ve broken down some personal factors, let’s look at the time it actually takes at a doctor’s office, urgent care center and emergency room.  

A Doctor’s Office Visit  

While having routine checkups with a primary care physician (PCP) is essential for overall physical and mental health, for non-emergent issues such as a sinus infection, rash or urinary tract infection, the time it takes to get an appointment with a PCP isn’t helpful. On average, Americans wait 24 days to see a PCP in-person. 7  

Once in the office, patients wait almost 20 minutes to be seen, even with an appointment. 8 These wait times are sometimes longer and are another deterrent for seeking care. A recent study revealed 30% of patients left their doctor’s office due to long wait times. 8  

After the time it takes to get to the doctor’s office and the time spent waiting, 1 in 4 doctors spend just 9-12 mins with a patient. 9 This is an inadequate amount of time for a PCP to cover symptoms and the patient’s history. Rushed appointments strain the doctor-patient relationship, diminishing trust and value-based care. The 15-minute care model is not beneficial to the patient. 10  

If an illness emerges during a doctor’s office off-hours, there is typically no way to access care. U.S. adults are the least likely of high-income countries to have a primary doctor to seek care from and are the least likely to have access to care during off-business hours, leading them to seek care at an urgent care center or emergency room. 11 This makes the time to get care even longer.  

The end result = 1 doctor’s visit is 2 hours (if you can get in to see a doctor before the average 24-day wait period)  

An Urgent Care Center Visit  

Much like a visit to a PCP, a trip to an urgent care center will take about two hours or more. But depending on the severity of your illness or injury and the number of other patients (and the severity of their illnesses or injuries), wait times can be much longer. Wait times in an urgent care center can range from 20 minutes to 90 minutes. 12  

Unlike a visit with a PCP, urgent care center visits are much more expensive. The average cost of urgent care center visits range from $100 to $150 and costs can be higher or lower depending on insurance coverage, annual deductibles and copays. 13  

The end result = 1 urgent care visit is 2-4 hours and costs can be confusing based on insurance coverage  

An Emergency Room Visit  

Higher-severity cases might bump a minor injury down the list, and emergencies aren’t scheduled. On average, the entirety of an emergency room visit is 2+ hours and costs more than $1,300. 14  

Almost 60% of emergency room visits come outside of business hours. 14 So, after enduring the wait time and exam, the wait times roll over to the next day to see the referred doctor or to visit a pharmacy during regular hours.  

A doctor should be someone a patient can trust. According to a recent study, 70% of providers told patients to go to an emergency room instead of an urgent care center, even though the patient indicated they would seek care at an urgent care center. 15 In turn, 56% of emergency room visits are completely avoidable and could save a patient thousands of dollars in out-of-pocket expenses. 14  

The end result = 1 emergency room visit is 4+ hours, expensive and likely avoidable  

Summary  

Whether it’s an emergency or a routine trip to your PCP for a simple sinus infection, a doctor’s visit takes much more time than we anticipate. It’s never as quick or affordable as we hope. Plus, a patient must also take into consideration pharmacy wait times and travel times if a medication is prescribed.  

As an alternative, First Stop Health Telemedicine and Virtual Primary Care provide fast, convenient solutions to a daunting necessity. You can’t just skip unavoidable medical care, but you can skip worrying about transportation, wait times, co-pays and time off work. First Stop Health members have 24/7 access to free, quality and convenient healthcare. Members can connect to doctors in under 6 minutes for Telemedicine and within 3 days for Virtual Primary Care.  Our virtual doctors are board certified in their field of medicine, can treat patients in all 50 states and Washington DC, and have 10 years of post-residency experience, on average.  

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/  
• https://www.naplesnews.com/story/news/health/2019/03/03/americans-average-34-minutes-road-see-doctor-study-shows/3020326002/  
• https://www.apta.com/news-publications/public-transportation-facts/  
• https://www.aha.org/ahahret-guides/2017-11-15-social-determinants-health-series-transportation-and-role-hospitals  
• https://www.valuepenguin.com/average-cost-child-care#:~:text=Parents%20in%20U.S.%20cities%20generally,typically%20pay%20more%20per%20hour  
• https://www.americanprogress.org/article/costly-unavailable-america-lacks-sufficient-child-care-supply-infants-toddlers/  
• https://medcitynews.com/2017/12/patients-waiting/  
• https://www.fiercehealthcare.com/practices/ppatients-switched-doctors-long-wait-times-vitals#:~:text=Across%20specialties%2C%20the%20average%20wait,patient%20waits%20depending%20on%20location .  
• https://www.statista.com/statistics/250219/us-physicians-opinion-about-their-compensation/  
• https://khn.org/news/15-minute-doctor-visits/  
• https://www.commonwealthfund.org/publications/issue-briefs/2022/mar/primary-care-high-income-countries-how-united-states-compares  
• https://www.advisory.com/daily-briefing/2012/12/04/member-asks#:~:text=The%20Urgent%20Care%20Association%20of,as%20long%20as%2090%20minutes .  
• https://www.debt.org/medical/emergency-room-urgent-care-costs/  
• https://journals.sagepub.com/doi/10.1177/1062860617700721  

Originally published Jul 4, 2022 2:00:00 PM.

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How Much Does Healthcare Cost in the USA?

What you need to know about healthcare costs in the united states.

People often warn visitors to America to purchase a health insurance plan before their trip because of horror stories about healthcare costs in the USA. They talk about outrageous bills for the uninsured party who finds themselves in trouble. But these dramatic stories don't really reflect the cost of healthcare in the United States - or do they? Here’s what you need to know about the cost of healthcare in the U.S. to make the best choices for your trip.

Despite its mixed reputation, healthcare in the United States performs exceptionally well in many regards. For instance, it has the best outcomes in the world for surviving a heart attack or stroke. However, it does not do well when it comes to chronic conditions like diabetes and asthma.

Waiting times, a concern in many countries with advanced health care systems, are less of a problem in the United States. Preventative health care spending is only slightly lower than in other industrialized nations. Overall, the standard of healthcare in the United States is very high. But so is the average cost of healthcare in the U.S.

US Health Insurance Plans Coverage and Costs of Insurance in the USA

If you reside in the US and your parents are planning a visit, consider one of the three travel insurance plans for parents visiting the USA .

What Is the Cost of Healthcare in the US Without Medical Insurance?

Below are average American healthcare prices for common procedures and services. These are estimates. The actual costs will vary depending on the healthcare facility providing the services. The infographics below will give you a good overview of the costs you may incur when visiting a doctor or hospital without insurance. These are the prices a visitor to the USA may face if they do not have a travel insurance plan or international health insurance plan .

These infographics list some of the typical, routine or unforeseen medical services that people require, along with their average costs. Much of this data comes directly from U.S. hospitals, which are required to list the cost of 300 of the most common medical procedures. As you will see, the cost of a doctor's visit or the average cost of a hospital stay in the U.S. varies widely depending on the services you need.

What Is the Cost of an Emergency Room Visit?

If you become ill and in need of emergency care, American healthcare prices will start adding up right away. An ambulance to take you to the hospital will start at $400. If you need tests, typical additional costs are $100 - $500. Should you need to spend the night, an additional charge of $5,000 might be added to your bill. With medications to treat your illness, the total cost of an emergency room or ER visit could be $6,000 or more!

What Is the Cost of Cancer Treatment Without Insurance?

Having cancer is enough to make anyone feel anxious about the uncertain road ahead. So any unwelcome medical costs will only add to those stress levels if you are uninsured. And, unfortunately, the costs for treatments in the U.S. \come with a high price tag. Nearly breaking the million-dollar mark is a bone marrow transplant. It could cost more than an eye-watering $900,000+. Prices start at a still pretty extortionate $638,000.

Brain cancer treatment costs anything from $50,000 to a lofty $700,000+, while breast cancer costs range from $48,500 through to $300,000+. The price it takes to tackle pancreatic cancer starts from $31,000 through to $200,000+. And melanoma treatment can be anywhere from $1,700 to $152,000+.

What Are the Costs of Common Lab Tests Without Insurance?

If a doctor is trying to diagnose your medical problem, common lab tests are important. But this is another area where the cost of healthcare in the US is high. An MRI scan will cost from $500 and up to, if not beyond, a costly $7,850+. A blood test, one of the most frequent lab tests, could be a seemingly low $40 but can ramp up to a staggering $3,000+. A cholesterol test at a walk-in clinic can be $50 to $130+ and $40 to $75+ for an at-home kit. An X-ray can cost between $200 but might also creep up to $3,000+ or more, depending on the circumstances.

What Could Prescription Drugs Cost?

American healthcare prices are also high when it comes to prescription medication. If you have diabetes and need insulin, you could be facing a cost of $530 to more than $1,100+. A year’s worth of allergy shots will set you back $600 to $2,000+. If you require cholesterol medication, you could see a $30 to $130 bill. Asthma inhalers cost between $60 and $70+. Prescription drugs can become a big part of a patient's budget.

What Is the Cost of Family Planning Without Insurance?

If you require pre-natal care, the average cost of a doctor's visit is between $100 and $2,000+. This adds up to a big total throughout even a single pregnancy. Should you go into labor and need assistance delivering your baby, this will cost anything from $2,700 up to and over $40,100.

Surgery in the form of a cesarean section costs between $10,600 and $50,500+. A postpartum check-up costs between $100 and $3,100+. If you have any birth complications, this tends to cost $3,000+ per day. And the average length of stay in the NICU is 20 days, meaning that you could potentially face a $60,000+ bill at the end of all your troubles.

What Does It Cost to Have Surgery Without Insurance in the USA?

Surgical procedures without a doubt save lives and improve outcomes. With health care costs in the USA, there's a high price to pay for the privilege. That's why we have broken down the ramifications for you. As you can see, the wide range of fees makes the average cost of a hospital stay in the U.S. hard to pin down. Coming in as the most expensive surgical procedure is the coronary artery bypass, which costs, at a minimum, $21,500 up to an astronomical $254,000+ or more.

Appendicitis attacks tend to come on quickly and require urgent attention, and that emergency appendectomy costs anywhere between $1,800 and $82,000+. Gallbladder removal costs between $8,000 to or even above $54,000. A hysterectomy starts at $8,700 but can shoot up to $40,000+. Cataract surgery is between $330 and $12,000+. That's the same as the uppermost cost of a tonsillectomy, where the lowest prices are a more reserved $790.

What Is the Cost of a Broken Bone or Sprain?

It could be an innocent tumble on the sidewalk, right through to a dramatic sporting injury. Whatever the scenario, breaks and sprains happen all the time and they are expensive for the uninsured.

A hip fracture starts at $16,000 for treatment, and goes up to $53,000+. A sprained or broken ankle could cost $300+ if surgery is not needed. But it soon jumps to a rather more unpalatable $17,000 to $20,000+ if a trip to the operating room is involved. A sprained or broken wrist costs $500+ on a non-surgical basis and leaps to $7,000 to $10,000+ if surgery is required. The resulting physical therapy will also cost you, coming in at $120 to $350 per session.

How Much is a Doctor's Visit in the United States?

A visit to the doctor's office is relatively affordable. However, if you are ill, additional costs will become expensive quickly. An initial consultation with a doctor will cost around $100 - $200. Visits to specialists are typically more expensive depending on their specialty and the nature of your visit. On average, specialists will charge $250 or more for a consultation.

What Is Behind Healthcare Costs in the USA? Why Are Medical Prices So Expensive?

Whether you are a local or a traveler, you cannot deny that the average cost of healthcare in the U.S. is expensive. According to USA Today : “The total costs for a typical family of four insured by the most common health plan offered by employers will average $28,166.” In terms of real dollars and earnings, these prices are keenly felt by the average person.

The cost of deductibles and premiums has grown at a faster rate than income. Deductibles (the amount you pay before your insurance starts to pay for covered services) grew 68.4% from 2011 to 2021, to an average $1,669, according to a report from the Kaiser Family Foundation . In addition, insured people are even more likely to have deductibles in their plans – 85% versus 74% in 2011. On top of that, premiums grew by 47% while worker earnings grew by only 31%. These figures alone prove how expensive healthcare in the USA has become and why even residents have a hard time paying for hospital bills.

The high average cost of healthcare in the U.S. is not the result of one particular challenge but rather a combination of factors that all contribute to increasing the bottom line. As CNBC noted ; “...drugs are more expensive. Doctors get paid more. Hospital services and diagnostic tests cost more. And a lot more money goes to planning, regulating, and managing medical services at the administrative level.” These factors, when put together, create a situation that makes it hard for the ordinary person to pay for medical care, especially when they do not have any health insurance in America to cover their expenses.

The Cost of Medical Care in America With Insurance

If you never go to the doctor, you won't experience these high costs. Some people feel comfortable taking that risk. But for the majority, the risks are too high.

For an expat or visitor in the USA, the best way to offset that risk is to purchase an international health insurance plan. Although a plan requires you to pay a fixed amount even if you never go to the doctor, it will cover your costs for the services detailed in the policy. A high-quality health insurance plan will cover all your costs, minus a deductible , excess, and/or co-pay (the fixed amount you pay for a covered service such as a doctor's office visit - even after you've met your deductible). Plans with higher deductibles and co-pays tend to have lower monthly fees, and vice-versa.

Depending on the plan you choose, all your costs could be covered without limit. But there are certain plans that will put a cap on how much they will pay for your medical expenses. This is called a medical maximum .

Choosing a health insurance plan in the USA with a lower medical maximum will lower your monthly premiums but you will take on additional risks in exchange. If your medical bills exceed the maximum, any additional costs will be your responsibility.

Due to all these factors, the cost of health insurance in America will vary. The cost of an international health insurance plan will be much greater than the cost of a travel medical insurance plan because the former offers more comprehensive coverage. Typically, our clients pay an average of $500 per month for comprehensive global medical health insurance. Compared to paying a $10,000 medical bill out of your own pocket, you can deduce that these premiums are reasonable.

Read: How Much Insurance Do Foreigners Need in the USA ?

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Common Costs in the USA Compared To Other Countries

How do the high average cost of healthcare in the U.S. impact the price of common medical procedures and treatments? Let’s look at the cost of an MRI, a frequently used diagnostic tool. All costs listed are from the most recent survey by International Federation of Health Plans , done in 2017. It's important to note that the costs listed below are lower than current U.S. prices; as noted earlier in this article, United States healthcare costs have gone up significantly since 2017.

The average cost of an MRI in the United States, according to the 2017 report, is $1,430. In Holland it's $190 while in New Zealand the price falls in the middle at $750.

The average cost of an angioplasty, which inserts a stent in a blocked blood vessel, was $32,200 in the United States at the time of the report. Meanwhile, in Switzerland, famous for both its high cost of living and its near-perfect health care standards, it's only $7,400.

When you take all of these into account, a common malady among travelers like abdominal pain suddenly becomes very costly. It will require diagnostic imaging and 24 hours of observation, which as discussed above is astronomically expensive. This is just for the diagnosis. Add in treatment and care, and the price goes up further. You can see why the average cost of a hospital stay in the U.S. is so high.

If that abdominal pain is found to be caused by an inflamed appendix that requires immediate surgery , it will cost you an average of $15,200 in the United States, according to the 2017 report. If you are in cost-friendly South Africa, it will be a meager $3,200. On the other hand, things will be a bit more expensive in the UK at $5,100 - that is still over $10,000 less expensive than getting the same treatment in the United States!

On the more dramatic end of the scale, both in terms of pricing and health risks, a bypass operation costs an average of $78,100 in the United States. In The Netherlands, it will cost only $11,700, according to the 2017 report. Either way, the cost of the operation is still far too expensive than what the average person can afford. Getting treated in The Netherlands, however, will be far less likely to cause medical bankruptcy compared to when you undergo the same procedure in the USA.

How Can You Cover Your Medical Costs in the USA?

So what can a frugal traveler or expat do? How do you reduce the cost of receiving proper health care without sacrificing quality or convenience?

Firstly, reassure yourself that common over-the-counter medications and first aid supplies are widely available and very affordable in the United States. Headache medication, mild heartburn medication, muscle cream, sinus decongestant pills, and skin ointments are all available for under $25; sometimes they're as cheap as $5.

A chat with a pharmacist is always free and they can provide sound recommendations for treating non-urgent, minor conditions. A bad cold is no more costly in the United States than it is in most other countries.

Secondly, make sure that you have health insurance in the USA. As you've seen up above, if you are traveling and fall ill, a relatively uncomplicated problem like an inflamed appendix can cost several times more than the trip itself. For non-residents, there is health insurance in the USA for foreigners that can greatly reduce costs of medical services, especially when you need them.

You do not need to face a life-threatening problem and then get slammed with sanity-threatening costs after. There is a wide variety of insurance products and packages designed for travelers. They range from the extremely comprehensive and inclusive to the more streamlined option, with a focus on coverage for the most serious and expensive of emergencies.

There is also health insurance for non-residents that can provide basic coverage for the most common ailments. This could be very helpful since healthcare in the USA is some of the most expensive in the world.

A medical emergency is stressful enough when you are traveling. You do not want it to ruin your life as well as your trip. Get health insurance in the USA to avoid headaches and astronomic costs.

If you're moving or planning to move abroad or going on an international trip and require insurance, then please consider choosing us . Here at International Citizens Insurance, we provide consumers with a resource to research, compare and purchase plans for their relocation abroad or international trip.

Through our website, we can offer some of the very best international health insurance , travel medical insurance , group insurance , and travel insurance policies to people from all around the world.

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• For Foreigners in the US or US citizens abroad

*Disclaimer: the information shown in these infographics is directional to help decision-making. Medical costs and charges are subject to change at any time and vary greatly from one geographic location to another and from one insurance plan to another.

Author: Joe Cronin , Founder and President of International Citizens Insurance . Mr. Cronin, a former expat, is an authority in the areas of international travel, and global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce. Follow him on LinkedIn or Twitter .

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Cost of doctor visit by state

The following estimated costs are based on cash prices that providers have historically charged on average for doctor visit and will vary depending on where the service is done. The prices do not include the anesthesia, imaging, and other doctor visit fees that normally accompany doctor visit.

What happens at a doctor's visit?

People go to the doctor for routine physical exams as well as acute care when they get sick or injured. Visits to the doctor are important for preventing disease and managing any health problems. During your doctor’s visit, the physician checks your blood pressure, temperature, and heart rate. 

Your doctor may listen to your heart, check your ears, nose, and mouth, and perform a physical exam. They may also ask you about your medical history and the medications you take. Your doctor may want you to have blood drawn for laboratory testing during your doctor’s visit.

How long should a doctor’s visit last?

It’s common for your entire visit to the doctor to take a long time. From start to finish, your appointment may take well over an hour . Many patients sit in the waiting room before being called back for examination.

How long you’ll wait depends on your specific doctor’s office and how busy they are. Once you’re in the exam room, the visit with your doctor will go quickly. On average, patients spend about 20 minutes in the exam room with their doctor.

Why are doctor visits so expensive?

Doctor's visits are expensive for several reasons, including their offices’ administrative responsibilities and the cost of medical services. Your doctor’s office has to work with different insurance companies and pay administrative staff trained in medical billing. Your doctor charges for their services, lab work, or imaging they run and may charge facility fees as well.

How much does a doctor visit cost without insurance?

Without insurance, your doctor’s visit can cost hundreds of dollars. On average, people in the U.S. pay just under $400 for their annual physical exam at a doctor’s office if they don’t have insurance. These costs include the provider fee for seeing the doctor and costs for any blood work or imaging that’s needed.

What are the signs of a bad doctor?

Know the warning signs of a bad doctor so you can avoid problems and get better medical care. One sign is if your doctor doesn’t listen to you or take your concerns into account during your visit. Another is if your doctor rushes through your appointment, not giving you the time needed to deal with your concerns.

A third warning sign is if your doctor doesn’t explain why certain tests or treatments are needed in a way you can understand.

What should you not tell your doctor?

Your doctor doesn’t need to know every detail about your life to provide proper care. But they do need you to be truthful about your health. You should never lie about the symptoms you’re experiencing or the medications you’re taking. If you aren’t taking medications as prescribed, your doctor needs to know. You don’t need to tell them health details they already know or give them any of your financial information.

Costs vary by specialty

The cost of a doctor visit could vary depending on the specialty. To see the cash prices for a specialist visit, type is a specialty.

* Savings estimate based on a study of more than 1 billion claims comparing self-pay (or cash pay) prices of a frequency-weighted market basket of procedures to insurer-negotiated rates for the same. Claims were collected between July 2017 and July 2019. R.Lawrence Van Horn, Arthur Laffer, Robert L.Metcalf. 2019. The Transformative Potential for Price Transparency in Healthcare: Benefits for Consumers and Providers. Health Management Policy and Innovation, Volume 4, Issue 3.

Sidecar Health offers and administers a variety of plans including ACA compliant and excepted benefit plans. Coverage and plan options may vary or may not be available in all states.

Your actual costs may be higher or lower than these cost estimates. Check with your provider and health plan details to confirm the costs that you may be charged for a service or procedure.You are responsible for costs that are not covered and for getting any pre-authorizations or referrals required by your health plan. Neither payments nor benefits are guaranteed. Provider data, including price data, provided in part by Turquoise Health.

The site is not a substitute for medical or healthcare advice and does not serve as a recommendation for a particular provider or type of medical or healthcare.

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Americans Make Nearly Four Medical Visits a Year On Average

For immediate release: august 6, 2008.

Contact: CDC National Center for Health Statistics, Office of Communication (301) 458-4800 E-mail: [email protected]

Patients in the United States made an estimated 1.1 billion visits to physician offices and hospital outpatient and emergency departments in 2006, an annual rate of nearly 4 visits per person annually, according to new health care statistics ( NHSR #8 [PDF, 624 KB]) released today by CDC’s National Center for Health Statistics (NCHS).

Ambulatory Medical Care Utilization Estimates for 2006. NHSR Number 8. 32 pp. PDF Version (624 KB)

The data come from various components of the CDC/NCHS National Health Care Survey and are featured in a series of new National Health Statistics Reports (NHSR). Some of the findings on ambulatory medical care in the U.S. include the following:

• The number of medical visits to physician offices and hospital outpatient and emergency departments increased by 26 percent from 1996 to 2006, faster than the growth of the U.S. population, which rose by 11 percent. The rise in visits can be linked to both the aging of the population, as older persons have higher visit rates than younger persons in general, and an increase in utilization by older persons ( NHSR #8 [PDF, 624 KB]).
• In 2006, 7 in 10 medical visits to these three settings had at least one medication provided, prescribed, or continued, for a total of 2.6 billion drugs overall. Analgesics were the most common therapeutic category, accounting for 13.6 percent of all drugs prescribed, and were most often utilized at primary care and emergency department visits ( NHSR #8 [PDF, 624 KB]).
• Over one-third of medical visits for African-American patients were to hospital emergency and outpatient departments as opposed to physician offices — 37.7 percent compared with 17.2 percent for white patients ( NHSR #8 [PDF, 624 KB]).
• Hispanic or Latino persons had a rate of preventive care services at hospital outpatient departments that were twice the rate for non-Hispanic persons (11.9 compared with 5.8 visits per 100 persons) ( NHSR #4 [PDF, 617 KB]).
• The emergency department served as the route of admission to hospital inpatient services for one-half of nonobstetric hospital patients in 2006, a marked increase from 36 percent in 1996 ( NHSR #7 [PDF, 697 KB]).
• Patients enrolled in Medicaid use the emergency department more frequently than patients with private insurance -– 82 per 100 persons for Medicaid compared with 21 per 100 for private insurance ( NHSR #7 [PDF, 697 KB]).
• Most emergency department visits occurred after business hours (defined as 8 a.m. to 5 p.m. on weekdays), when 63 percent of adults and 73 percent of children younger than age 15 arrived ( NHSR #7 [PDF, 697 KB]).
• On average, the number of patient arrivals at the emergency department leveled off at 10 a.m., but occupancy in the emergency department did not peak until 7 p.m., as new visits and admitted patients waiting for a hospital bed accumulate ( NHSR #7 [PDF, 697 KB]).
• One-half of physician office visits were made by patients with one or more chronic conditions. Hypertension was the most frequent condition, followed by arthritis, high cholesterol, diabetes, and depression. Since 1996, visits by adults with diabetes, hypertension, and depression have all significantly increased ( NHSR #3 [PDF, 855 KB]).
• Between 1996 and 2006, the percentage of visits to hospital outpatient departments made by adults 18 years and over with chronic diabetes increased by 43%, and visits with chronic hypertension increased by 51% ( NHSR #4 [PDF, 617 KB]).

One of the new reports focuses on hospitalization rates and inpatient characteristics and includes the following findings:

• Over the past 36 years, the percentage of hospital inpatients who were 65 years of age and over grew from 20 percent in 1970 to 38 percent in 2006. Over the same time period, the percentage of inpatients who were 75 years of age and over grew from 9 percent to over 24 percent ( NHSR #5 [PDF, 770 KB]).
• The rate of knee replacement for those aged 65 years and over increased 46 percent between 2000-2006 whereas the rate doubled among those aged 45-64 years during the same time period ( NHSR #5 [PDF, 770 KB]).
• The rate of coronary atherosclerosis more than doubled during the 1990s, but since 2002 declined for all age groups, particularly for those aged 65 years and over ( NHSR #5 [PDF, 770 KB]).

National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. NHSR Number 7. 39 pp. PDF Version (697 KB)

2006 National Hospital Discharge Survey. NHSR Number 5. 20 pp. PDF Version (770 KB)

National Hospital Ambulatory Medical Care Survey: 2006 Outpatient Department Summary. NHSR Number 4. 32 pp. PDF Version (617 KB)

National Ambulatory Medical Care Survey: 2006 Summary. NHSR Number 3. 40 pp. PDF Version (855 KB)

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This hospital is the first in the U.S. to do visits via hologram

LANCASTER, Texas (WFAA) - Patients at a hospital in Texas may be in for a shock when they step into an examination room.

Instead of consulting with their doctor in person, they will be talking to them via a hologram.

At first glance, Crescent Regional looks like any other hospital but there is something that sets it apart from others.

Dr. Saad Hussain teleported to this hospital in Lancaster, Texas, from several cities over to meet with a patient via hologram in 3-D, real-time and life-sized.

Crescent Regional’s CEO Raji Kumar said her hospital is the first in the nation to ever do it.

“I’m super excited of being able to bring some of this technology to north Texas,” she said.

It is cool, but you might be wondering: what’s the point?

Well, here is an example: The hospital has a clinic 45 minutes away. Instead of driving back to the hospital for a simple pre-op, post-op or follow-up appointment, providers like Hussain can simply step into the clinic’s studio.

“You just turn it on and they let you know the patient is already there,” Hussain said.

A monitor, microphone and camera teleport them to the hospital.

“And you can do the examination and stuff on the video call,” Hussain said.

Kumar plans to put more studios in doctors’ offices and homes, and more holoboxes in her hospital so doctors can teleport directly into patient rooms and emergency rooms.

“When I see the patient live there in the emergency room, that will give me more sense of what’s going on over there,” Hussain said.

In an interview via the holobox, Hussain said a hologram is as close to in-person as it gets.

“Patient is seeing you and it looks more like closer to reality then definitely patients get more comfortable, you know?” he said.

The hospital said the new technology could change the future of medicine.

Kumar hopes to add the technology to a mobile van and take it to underserved areas.

Copyright 2024 WFAA via CNN Newsource. All rights reserved.

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