Hoosiers are less likely to undergo routine cancer screenings or take their children to an annual checkup than residents of other states, according to a new report commissioned by the Indiana Business Health Collaborative.
The report found Indiana trails the nation and neighboring states in key areas of primary and preventative care access. Investments in both areas could contribute to efforts by lawmakers to curb medical costs by shifting patients away from the emergency department and high-cost specialty care through early detection and chronic disease management.
“Indiana has taken important steps, but we are still underinvesting in the front end of care — where the greatest impact can be made,” Beth Lock, CEO and executive director of the collaborative, said in a news release. “For employers, this shows up in higher costs, more complex conditions and a workforce that isn’t as healthy as it could be. Strengthening primary care and making prevention more accessible are among the most practical steps we can take to improve both health outcomes and economic performance.”
The Center for Health Policy at the Richard M. Fairbanks School of Public Health at Indiana University-Indianapolis released the report for the group Monday.
Few primary care providers
The report found there are fewer primary care physicians practicing in Indiana than in neighboring states of Ohio, Michigan and Illinois and in the nation overall, at a time when fewer medical residents are entering the specialty to replace retiring physicians.
There are an average of 66 primary care physicians per 100,000 Hoosiers compared to 75 primary care doctors per 100,000 people nationally, the report found.
The report found primary care accounts for 6% of employer-sponsored health care spending in Indiana, compared to 30% nationwide.
Indiana trails peer states in routine preventative services like cervical cancer screenings and pediatric well visits, with only 77% of Hoosier children finishing their recommended annual checkups.
Meanwhile, the percentage of Hoosier adults who attended a routine checkup within the past year increased from 77% in 2018 to 80% in 2024, surpassing the national 78% average.
The Hoosier state performs well in primary care access for Medicare beneficiaries, which the report authors suggest shows targeted coverage and reimbursement structures can improve access.
Indiana also surpassed the national average for access to adolescent mental health treatment — 85% of Hoosier teens in need of mental health care were able to access it, the report found.
Hoosiers are roughly as likely as Americans overall to get a flu vaccination, visit the dentist or check their cholesterol each year, but are less likely to undergo recommended cancer screenings, the report found.
The IBHC, a statewide coalition of employers, economic development organizations and health care industry stakeholders, commissioned the report to guide its policy and market-based priorities, as well as form potential recommendations for the 2027 legislative session.
“What we found is pretty clear: Indiana isn’t keeping up with other states on key measures of primary care and prevention,” Aparna Soni, associate professor of health policy management at the Fairbanks School, said in a news release. “Those differences are tied to worse health outcomes and greater reliance on more expensive care.”
Expanding access to under-served areas
The report comes as lawmakers and Gov. Mike Braun’s administration scrutinize health care costs in Indiana, bringing attention to what the report describes as a “clear and often overlooked opportunity” to invest in primary and preventative health care.
The report outlines evidence-based strategies to improve access to primary and preventative care while bringing overall costs down.
Among those strategies are expanding the scope of practice for nurse practitioners and physician assistants to lessen the burden on primary care doctors, as well as expanding primary care medical residencies in communities where few doctors practice.
The report also suggests raising reimbursement rates for primary care providers, expanding team-based and collaborative care models and increasing support for federally qualified health centers and community clinics.
The authors say there is convincing evidence that expanding health insurance coverage, whether through Medicaid or employer-sponsored insurance, leads to higher utilization of primary and preventative care, especially for low-income people.
Still, the report notes that while increased utilization of primary care can reduce health care spending by catching issues early, over-use of preventative care can increase upfront costs – from the initial cost of screening and treatment of early-stage cancers to follow-up tests and potential for false positive results.
To mitigate these risks, the report suggests targeting populations at high risk of disease, as well as investments in continuity, comprehensive care and proactive care management.
The report also highlights potential for artificial intelligence and emerging technologies to enhance the return on investments in primary and preventative care, such as through automatic patient reminders, though outcomes are not fully studied.
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