Good primary health care makes health systems more inclusive and performing
As societies age and the burden of chronic disease grows, people need care that is centred on increasingly complex care needs, co-ordinated across the care pathway, and accessible (financially, geographically and around the clock). This makes good primary health care ever more vital. As the first point of contact, providing comprehensive health care, good primary health care:
- Improves health and helps to fight inequalities, through improved financial access to care, targeted preventive actions within the community, and disease management programmes. Across OECD and EU countries, 68% of people with lower-income have seen a GP in the past 12 months (versus 72% in the higher income group), a rather small difference.
- Fosters people empowerment and centredness, notably through improving people health literacy.
- Makes health system more efficient, for example by reducing rates of avoidable hospitalisations and unnecessary emergency department visits.
Yet primary health care is still too weak
- Across EU countries, 26% of patients suffering from some chronic conditions did not receive any of the recommended preventive tests in the past twelve months.
- Avoidable admissions for chronic conditions that should be treated in primary health care were equivalent to 6.1% of hospital bed days in 2016, costing at least US$ 835 million on average across OECD countries.
- The inappropriate use of antibiotics in general practice ranges between 45% and 90%. High levels of antibiotics consumption increase the risks of resistant strain, costing lives and money.
Strengthening it requires the right resources and organisation
To deliver high quality and accessible people-centred care, more needs to be done to strengthen primary health care, notably focus on:
- Right resources. Investing in primary health care generates good returns for society but this requires adequate resources. Yet only 14% of total health spending is currently devoted to primary health care across OECD countries, while the share of general practitioners as a share of all doctors has dropped from 32% in 2000 to 29% in 2016 across OECD countries.
- Right organisation. There is an urgent need to shift from the reactive solo-practice primary health care model to a proactive, preventive and participatory approach. In 2018, only 15 OECD countries had primary health care services based on teams or network. Robust and portable Electronic Health Record (EHR) across the care continuum is also key for proactive, peoplecentred primary health care.
- Right incentives. While 13 countries introduced innovative payment models in primary health care in recent years, there is scope for greater diffusion of new payment systems incentivising quality care, greater care co-ordination and prevention for people with complex needs.
- Right measurement. There are too few efforts nationally and internationally to measure the outcomes of primary health care. While experience measures are collected in 18 OECD countries, hardly any country surveys patient reported outcomes within primary health care.