Primary care improves population health by delivering preventive services, addressing social needs, and maintaining long-term patient-clinician relationships. Access to primary care benefits patients through disease prevention, management of chronic conditions, and reductions in hospitalizations and overall costs.
Given the many benefits of primary care, researchers in Canada recently conducted a study investigating the impact of “primary care unattachment,” or a patient’s loss of access to a primary care provider.
Research Focus and Findings
The study examined health outcomes between April 2023 and March 2024 among a sample of 12.7 million Ontario residents, 11.5 million of whom had primary care physicians and 1.2 million of whom did not. It looked at several types of outcomes, including mortality and healthcare costs.
The researchers found that the odds of mortality from any cause after unattachment from a primary care provider were 80% higher during the first two years of unattachment compared to those who had attachment to a primary care provider for 15 years or more. Even more strikingly, among patients with multiple health conditions, primary care unattachment was associated with a twelvefold higher likelihood of mortality from any cause within the first two years compared to those who had primary care attachment for 15 years or more.
When the researchers restricted the sample to individuals who had healthcare costs, they found significantly higher total healthcare costs, inpatient costs, and emergency department costs for those who had no attachment to a primary care provider compared to those who had attachment to a primary care provider.
Insights for Arkansas
Investment in primary care in Arkansas has decreased in recent years. The state’s primary care spending as a share of total healthcare spending among adults ages 18-64 was 7.1% in 2023, down from 9.1% in 2019, according to according to The Commonwealth Fund’s 2025 Scorecard on State Health System Performance.
Additionally, KFF has estimated that Arkansas is only meeting 53.5% of its primary care need. The state would need to add 177 primary care physicians to have no primary care shortage areas, according to KFF.
Arkansas has launched recent efforts to address primary care shortages, including the addition of 22 family medicine residency slots at the University of Arkansas for Medical Sciences and the General Assembly’s passage of Act 483 of 2025, which created a Primary Care Payment Improvement Working Group tasked with assessing current primary care spending and service utilization and estimating future investment needs to strengthen access and capacity. Given the mortality risk and cost burdens associated with the lack of access to primary care, policymakers and healthcare institutions should continue pursuing strategies to improve primary care access in Arkansas.
