Municipal HR leaders and Benefits Managers are navigating one of the most challenging healthcare environments in recent memory. Rising medical costs, aging workforces, labor shortages, and increased expectations from employees all place sustained pressure on public-sector budgets. At the same time, municipalities are expected to maintain essential services while demonstrating responsible stewardship of taxpayer dollars.
Given this environment, many cities and counties are rethinking how healthcare is delivered to their employees. One solution continues to gain traction across the public sector: onsite primary care. Once considered a benefit reserved for large private employers, onsite clinics are now proving to be a practical, cost-effective strategy for municipalities looking to control healthcare spending while improving employee access and outcomes.
Healthcare costs remain one of the fastest-growing line items in municipal budgets. According to the Centers for Disease Control and Prevention, chronic conditions account for approximately 90% of U.S. healthcare spending, and municipal workforces are not immune to these trends. Conditions such as hypertension, diabetes, and musculoskeletal disorders are especially prevalent among public-sector employees in physically demanding roles like public safety, utilities, and public works.
At the same time, employer healthcare costs continue to rise year over year. The Business Group on Health reports that large employer healthcare costs increased by an average of 7.4% annually between 2022 and 2024, outpacing inflation and wage growth. For municipalities operating within fixed or voter-approved budgets, these increases can quickly become unsustainable.
Traditional healthcare delivery models often exacerbate the issue. Limited access to primary care leads employees to delay treatment or seek care in higher-cost settings such as emergency rooms and urgent care centers, driving up claims without improving long-term outcomes.
Access to primary care is one of the most powerful levers municipalities can pull to improve health outcomes and manage costs. Research consistently shows that strong primary care access is associated with lower total healthcare spending, fewer hospitalizations, and better chronic disease management.
Yet many municipal employees face barriers to accessing care, including long wait times, limited appointment availability, and time away from work. These challenges are especially pronounced for shift-based employees such as firefighters, police officers, and sanitation workers.
Onsite primary care removes these barriers by bringing care directly to the workplace or nearby. Employees can address health concerns earlier, receive preventive care, and manage chronic conditions without navigating a fragmented healthcare system. For municipalities, this shift toward early intervention can significantly reduce downstream costs.
The financial case for onsite primary care continues to strengthen. According to the National Association of Worksite Health Centers, employees who utilize onsite clinics experience fewer emergency room visits compared to non-users. These behaviors translate directly into lower claims costs for employer-sponsored health plans.
Additionally, studies show that onsite clinic users generate 23% lower total healthcare costs than employees who rely solely on community-based care. These savings stem from improved care coordination, reduced duplication of services, and a stronger focus on prevention.
For municipalities, these cost controls are particularly meaningful. Unlike private employers, public agencies must balance healthcare investments with competing priorities such as infrastructure, public safety, and community services. Onsite primary care allows municipalities to reinvest savings into both employee well-being and public-facing initiatives.
Cost control alone is not the only driver behind the growing interest in onsite care. Municipal leaders are increasingly focused on building healthier, more resilient workforces—especially as retirements accelerate and experienced workers leave the public sector.
Onsite clinics help support this goal by promoting continuity of care. Employees can develop relationships with providers who understand the unique demands of municipal roles and can tailor care accordingly. Over time, this trust leads to higher engagement, better adherence to treatment plans, and improved health outcomes.
The Integrated Benefits Institute reports that employees engaged in employer-sponsored primary care programs experience up to 20% fewer missed workdays, underscoring the connection between accessible care and workforce productivity. For municipalities, fewer absences mean more consistent service delivery and reduced overtime costs.
One common misconception is that onsite clinics are only feasible for very large cities or counties. In reality, today’s onsite care models are far more flexible. Shared-site and near-site clinics allow multiple municipalities or public agencies to participate in a single location, spreading costs while maintaining access and quality.
These models are especially attractive for smaller municipalities or those with geographically dispersed employees. By partnering with an experienced onsite care provider, municipalities can design solutions that align with workforce size, labor agreements, and budget constraints—without sacrificing outcomes.
As municipalities plan for the years ahead, healthcare strategy will continue to play a critical role in workforce sustainability. Onsite primary care offers a rare combination of benefits: improved access, better outcomes, stronger employee engagement, and measurable cost control.
By addressing healthcare challenges at the source through primary care, municipal leaders can move from reactive cost management to proactive workforce health. The result is a healthier organization better equipped to serve its community.
References:
Business Group on Health. (2024). Large employer health care strategy survey. https://www.businessgrouphealth.org/resources/2024-large-employer-health-care-strategy-survey-intro
Centers for Disease Control and Prevention. (2024). Chronic disease overview. https://www.cdc.gov/chronic-disease/about/index.html
National Association of Worksite Health Centers. (2024). Benchmarking report. https://nawhc.org/2025-benchmarking-survey-2/
Starfield, B., Shi, L., & Macinko, J. (2022). Contribution of primary care to health systems and health. Milbank Quarterly, 100(1), 65–99. https://pmc.ncbi.nlm.nih.gov/articles/PMC2690145/