The state of primary care in 2026: Barriers, costs, and a better path forward

Most people avoid healthcare not because they lack concern for their health. They avoid it because the system feels expensive, frustrating, and hard to navigate.

That frustration runs deep. In a recent General Atlantic survey commissioned by Marathon Health, more than half of respondents said the U.S. healthcare system is fundamentally broken.

To better understand what’s behind the sentiment, the survey explores how U.S. workers use primary care and how those experiences shape trust, engagement, and outcomes.

The findings paint a stark picture:

• 37% aren’t sure their doctors understand their needs or preferences
• 69% say their providers seem rushed or pressed for time
• 90% believe Americans are paying too much for the quality of care they receive

These perceptions matter, because when people feel unheard or rushed through appointments, they disengage. And disengagement leads to measurable consequences.

For instance:

• 38% of respondents avoid or delay routine checkups and physicals
• 28% haven’t seen their primary care provider in the past year because they didn’t feel sick enough
• 10% report having no primary care provider at all

Primary care should serve as the front door to the healthcare system. Instead, too many workers walk right past it. The survey findings offer a clear signal for employers looking to improve outcomes while controlling costs.

Barriers to primary care utilization

The survey identifies three core barriers to consistent engagement with primary care in 2026: cost, convenience, and commitment. 

1. Primary care doesn’t feel affordable

Cost remains one of the most powerful deterrents to care, with 35% of respondents reporting they delay or avoid primary care due to cost.

Even routine visits can feel financially risky for families navigating high deductibles and coinsurance. When workers worry about surprise bills, they postpone appointments.

On the other hand, the survey shows lower costs rank as the top factor that would motivate respondents to visit a primary care provider.

2. Primary care is difficult to access

When workers need care, they naturally choose the quickest, most convenient option, such as urgent care or the emergency room. These settings may offer faster access, but they lack continuity and cost significantly more.

In the traditional primary care system, patients face long waits for appointments and extended time in waiting rooms. Many must take time off work or pull children out of school just to attend a visit.

Survey respondents ranked long waits as the top reason for not seeing a primary care provider.

The survey shows:

• 26% of respondents skipped primary care in the last year because they were too busy or didn’t have enough time. The number jumps to 35% among those with multiple chronic conditions.
• 29% avoided care because they couldn’t get time off work or school.

Respondents identified several convenience-related factors that would encourage greater primary care use, including:

• Appointment times in the evenings or on weekends
• Shorter wait times for appointments and in waiting rooms
• Access to virtual telehealth visits
• More conveniently located offices
• Reminders or assistance with scheduling appointments (calls, texts, emails)

Put simply: Workers want primary care that fits into their lives, without jumping through hoops.

3. Primary care lacks consistent, reliable relationships

For many, avoiding primary care is an emotional decision.

Trust strongly influences when and where people seek care. After insurance considerations, the survey shows trust in providers ranks as the top factor in choosing preventive and chronic care settings, followed closely by having an established relationship with a primary care provider.

When patients feel known, heard, and respected, they return. When they feel rushed or dismissed, they disengage.

The 69% of respondents who feel their providers seem rushed point to a deeper issue: Primary care often lacks the time and structure needed to build meaningful patient relationships.

Employer-sponsored advanced primary care offers a return to true value-based care

Despite current frustrations, research consistently shows higher primary care visit rates correlate with measurable improvements in both health and cost, including:

• Fewer emergency department visits 
• Less hospitalizations
• Greater use of preventive measures such as vaccinations, mammograms, and colonoscopies
• Increase in life expectancy

With employer-sponsored advanced primary care, providers receive the tools, time, and incentives to deliver highly personalized care. They build ongoing relationships with patients rather than rushing through brief appointments. Patients gain a convenient, integrated destination for 90% of their health needs.

The survey shows 76% of employers currently offer APC or are considering adopting the model in the near future.

APC benefits to employees

Among the many benefits of advanced primary care, employees experience meaningful improvements in access and engagement, including:

• Unlimited and comprehensive access to in-person and virtual care 
• Same-day or next-day appointments
• A single destination for up to 90% of health needs
• No or low copays and coinsurance
• Providers financially accountable for quality and total cost of care

By eliminating financial friction and long waits, APC encourages consistent engagement and builds trust and long-term relationships.

APC benefits to employers

APC helps employers control costs while supporting a healthier, more productive workforce.

With Marathon Health’s APC model, clients see:

• $1,100+ in annual savings per engaged member
• $1,300+ in annual savings per engaged member with a chronic condition
• 82% higher primary care use among engaged members

These savings result from fewer emergency room visits, reduced hospitalizations, improved chronic disease management, and stronger preventive care participation.

More importantly, APC creates a culture of care. Employees feel valued when employers invest in accessible, relationship-driven healthcare. That trust translates into higher satisfaction, stronger retention, and better performance.

Get the full data behind the trends

Download the full report for deeper insights on workforce behavior, cost drivers, and the ROI of advanced primary care.