Health Insurance

Is Health Care Access Keeping Pace With America's Fastest-Growing Counties?

Is Health Care Access Keeping Pace With America's Fastest-Growing Counties?

There are now more insured people and fewer patients per primary care physician, but data suggests the cost of medical care is rising across these booming counties.
A doctor taking blood pressure measurements.
A doctor taking blood pressure measurements. Source: Getty Images

In the U.S. counties that experienced the most population growth in the past decade, health care access has generally kept up with incoming residents. ValuePenguin researchers found that in most of the counties whose population growth between 2010 and 2019 was greater than 75% of the country, the number of uninsured people and the number of patients per doctor fell.

There were, however, some areas where access changed for the worse. For example, in 57 of the 203 counties that researchers examined, the number of patients that an individual physician was responsible for rose. At the same time, medical care got more expensive throughout nearly all of the fastest-growing counties. Per-capita Medicare expenses rose by a total of $1,256 on average across these counties.

Key findings

Access to physicians improved in most of the fastest-growing counties, but the progress varied

In counties whose populations increased by at least 25,532 (the number indicating the top 25% of fastest-growing counties) between 2010 and 2019, there were more physicians and a lower number of patients for whom each doctor would be responsible for providing care.

Overall, there were 16 million more people in the fastest-growing counties in 2019 than in 2010. The total number of physicians in the period examined increased by 18,144, resulting in 1,227 patients per physician at the national level. At the beginning of the decade, there were 1,299 patients for every physician — meaning there were 72 fewer patients per PCP at the end of the decade.

Average increases across counties are much more measured, but still positive. On average, each of the fastest-growing counties had 90 more physicians at the end of the decade. In 2010, there were typically 1,602 patients per PCP at the county level in the fastest-growing counties. At the end of 2018, there was an improvement of 80 fewer patients that each single doctor was responsible for, on average, as the number of patients per doctor settled at 1,522.

In three counties — Sumter County, Fla.; Paulding County, Ga., and Pinal County, Ariz. — the number of patients for every physician decreased by at least 1,400. At the same time, there were only 20 more doctors, on average, in each of these counties at the end of the decade than at the beginning. These counties experienced an average population growth of 35,805 over the decade (38,346, 25,926 and 78,947, respectively). In faster-growing counties, the number of primary care physicians increased by far more than 20 at the end of the decade.

County and state
Population change
Physicians change (gross)
Change in patients per PCP
Maricopa County, Ariz.658,043481-44
Harris County, Texas602,554473-97
King County, Wash.314,821508-58
Clark County, Nev.312,455206-80
Tarrant County, Texas284,857180-37
Bexar County, Texas279,774367-194
Riverside County, Calif.267,214178-190
Dallas County, Texas258,165335-148
Collin County, Texas246,323381-249
Orange County, Fla.243,952394-258
Travis County, Texas243,148267-113
Hillsborough County, Fla.238,122238-88
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In the 15 fastest-growing counties by population, there were 121 fewer patients per every PCP at the end of the decade, an improvement of 49 patients per PCP across the fastest-growing counties. Patients' access to doctors got worse in only one of the 15 fastest-growing counties: Denton County, Texas.

Access to physicians didn't uniformly improve across the fastest-growing counties. In all, 57 of the fastest-growing counties saw the ratio of patients to doctors increase and access weaken. In these counties, there were 1,030 more doctors overall, but the number of residents increased by 2.7 million. This amounted to 77 more patients per doctor in these counties. Wilson County, Tenn., experienced the worst change — there were 667 more patients per PCP at the end of the decade there.

County and state
Population change
Physicians change (gross)
Change in patients per PCP
Wilson County, Tenn.30,120-1667
Midland County, Texas39,8570574
Johnston County, N.C.39,6043421
Clayton County, Ga.32,6330395
Clay County, Fla.27,857-12381
Ocean County, N.J.29,583-35361
Osceola County, Fla.105,91426273
Kaufman County, Texas32,2275229
Sumner County, Tenn.30,0334203
Macomb County, Mich.32,846-26166
Charlotte County, Fla.28,9206143
Cass County, N.D.31,6937141
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Fewer people are uninsured than a decade ago, but medical costs continue to rise in most places

While people are more likely to have access to medical professionals, the prospect of finding affordable medical care could be waning depending on the area. ValuePenguin researchers found that among the fastest-growing counties, wages increased by a median amount of $23,291 from 2010 to 2019. Increasing wages were accompanied by greater access to health insurance: nearly 8.2 million people gained public or private health insurance coverage during this time period, with an average per-county increase of 40,481.

At the same time, however, evidence suggests that the cost of medical care got more expensive across the board during the same time. On average, per-capita Medicare expenses grew by $1,256 across all of the fastest-growing counties. While the actual per-county change depended on the location, only two counties saw an overall decrease in per-capita Medicare expenses from 2010 to 2019.

Even in Orleans and St. Tammany parishes in Louisiana, expenses only fell by a total of $15 and $289 per capita, respectively.

The increase in health care spending stands to negatively affect those who lost or don't have insurance the most. There were 10 counties where more people were uninsured in 2019 than in 2010. Average Medicare expenses in these counties rose by $1,118 over the decade. Family wages in these counties grew by an average of $22,721 — slightly below the median of $23,291 for the fastest-growing counties.

County and state
People who lost insurance
Change in per-capita Medicare costs (2010 to 2019)
Bell County, Texas4,345$1,288
Hays County, Texas2,625$1,161
Paulding County, Ga.2,413$1,427
Washington County, Utah2,138$1,044
Rockwall County, Texas1,852$897
Clay County, Mo.1,610$1,071
Canadian County, Okla.961$1,511
Cherokee County, Ga.737$1,240
Ellis County, Texas648$980
Fort Bend County, Texas573$558
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Broadly speaking, health care expenses of all kinds grew markedly from 2010 to 2019 across the country. While total expenditures grew by $1.2 trillion during this time period, out-of-pocket health care costs grew by $920 billion nationwide. Paling in comparison to this figure were the growth rates of Medicaid and Medicare spending. Medicare expenditures grew by $216 billion, while Medicaid spending went up by nearly $121 billion.

How can consumers find affordable health care?

Medicaid and Medicare often have the lowest out-of-pocket costs, but subsidies could make Affordable Care Act policies more affordable for those who aren't eligible for coverage.

People who remain uninsured but who don't qualify for other public forms of coverage may be able to find affordable health insurance by comparing marketplace rates. Shoppers could find differing rates according to their general health, the expected prescriptions and procedures they would need, and the health insurance companies available in their location. Other factors that influence rates include the deductible and out-of-pocket maximum they could afford.

It could be a particularly advantageous time to consider purchasing a marketplace policy. The coronavirus pandemic has produced longer extensions on the enrollment period for getting health insurance. Moreover, tax credits passed in the first quarter of 2021 mean that many Americans could get heavily discounted — or, for those who lost their jobs in the past year, even free — coverage.

Methodology

This study combines wage, insurance and population data from the U.S. Census Bureau's American Community Survey one-year estimates for 2010 through 2019. It also uses tabulations for Medicare expenses and the number of physicians from 2010 to 2019 and 2010 to 2018, respectively. Medicare data is sourced from the Centers for Medicare and Medicaid Services (CMS), while data pertaining to physicians per county comes from the 2021 County Health Rankings report.

This study focuses on the counties listed in the American Community Survey's one-year estimates that experienced population growth equal to or greater than 25,532 from 2010 to 2019. This number represents only the fastest-growing counties, as it is greater than three quarters of the population change experienced elsewhere.