Comparing Comprehensiveness in Primary Care Specialties and Their Effects on Healthcare Costs and Hospitalizations in Medicare Beneficiaries

Four essential features of primary care, identified by Barbara Starfield, include the following: first contact, continuity, coordination, and comprehensiveness.1 Comprehensiveness, defined as offering a “range of services broad enough to care for all health needs except those too uncommon to maintain competence,” includes meeting the large majority of each patient’s physical and mental healthcare needs.1 However, while comprehensiveness is thought to be in decline among primary care physicians (PCPs), little has been done to capture its value in policy-relevant terms such as cost and quality, important in this era of value-based purchasing.2 A recent study developed and tested a measure of comprehensiveness among family physicians revealed a modest association with lower healthcare utilization and costs among Medicare patients.3 This paper extends this work by comparing family physicians and general internists in comprehensiveness and its impact on similar outcomes.