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Realising the Potential of Primary Health Care Realising the Potential of Primary Health Primary Care OECD Health Policy Studies OECD Health Policy Studies Realising the Potential of Primary Health Care Realising the Realising Potential of Potential Primary Health Care Primary Health OECD Health Policy Studies Realising the Potential of Primary Health Care This work is published under the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of OECD member countries. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law. Note by Turkey The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United Nations, Turkey shall preserve its position concerning the “Cyprus issue”. Note by all the European Union Member States of the OECD and the European Union The Republic of Cyprus is recognised by all members of the United Nations with the exception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus. Please cite this publication as: OECD (2020), Realising the Potential of Primary Health Care, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/a92adee4-en. ISBN 978-92-64-93333-0 (print) ISBN 978-92-64-56162-5 (pdf) OECD Health Policy Studies ISSN 2074-3181 (print) ISSN 2074-319X (online) Photo credits: Cover © Photographee.eu/Shutterstock.com. Corrigenda to publications may be found on line at: www.oecd.org/about/publishing/corrigenda.htm. © OECD 2020 The use of this work, whether digital or print, is governed by the Terms and Conditions to be found at http://www.oecd.org/termsandconditions. 3 Foreword Even before the COVID-19 pandemic, health systems in OECD countries faced significant challenges. Citizen expectations about health services are high, societies are ageing, health spending is rising in response to more complex health needs, and fiscal pressures make it difficult to expand allocations of resources to the health sector. The rapid spread of COVID-19 added complexity to these challenges, given both the surge in demand for treatment of the acutely ill and the need to continue to deliver preventive care and manage chronic patients. In this context, primary health care plays a key role for health systems to deliver more and better services. As the first point of contact that is expected to address the majority of health needs, strong primary health care has all the potential to improve health outcomes for people across socio-economic levels and to reduce unnecessary use of more expensive specialised services. But is primary health care across the OECD ready and living up to these expectations? Realising the Potential of Primary Health Care discusses how primary health care across OECD countries needs to evolve to meet the health challenges that OECD health care systems – and societies more broadly – are facing in the 21st century. It identifies key policy ingredients that countries need to implement to realise the full potential of primary health care. Even in the aftermath of the COVID-19 pandemic, these remain as important as ever, as primary health care is expected to continue to address the majority of health needs. Based on data collected before the COVID-19 pandemic, the report uses a mix of quantitative and qualitative analyses, including information collected through a policy survey covering 26 countries, to suggest key policies and strategies to deliver better primary health care and create stronger primary health care systems. It highlights examples of useful -often local- country experiences. Realising the Potential of Primary Health Care stresses that there are far too many countries with unrealised opportunities from better primary health care. High-quality primary health care is not always delivered, with avoidable hospital admissions still representing 6% of hospital bed-days across 30 OECD countries for which data are available. Estimates of inappropriate antibiotic prescriptions in primary care range from 45% and 90%. One-quarter of patients suffering from chronic conditions in EU countries did not receive any preventive tests in the past 12 months. Between 29% and 51% of people in 11 OECD countries reported having experienced problems of co-ordination between primary care and specialised care. New service delivery models, better economic incentives, and broader roles for patients are needed to boost effective, efficient and equitable health systems. Models of organising services that are based on multi-professional teams or networks are being developed in less than half of OECD countries. Better co-ordination among primary care and other providers requires efforts to reward and encourage team work. There is ample scope for further developing the role of primary care nurses and pharmacists, and develop more effective collaboration with general practitioners and other health services. Better use of digital technology, and ability to link datasets across primary care and other part of the health systems is also necessary. Payment instruments linked to outcomes (e.g. for patients with chronic conditions) or desired activities (e.g. vaccination, coordination) are needed to improve care. Better measurement of the inputs, outputs and outcomes of the primary health care sector is vital to improve performance. Patients also need REALISING THE POTENTIAL OF PRIMARY HEALTH CARE © OECD 2020 4 improved ability to access – and interact with – their own records, especially key for those living for many years with chronic conditions. Countries will certainly conduct thorough reviews of the provision of health care as they seek to draw lessons from the COVID-19 pandemic. Modernising primary health care services is critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services. As this report shows, while the seeds for the future of primary health care are present in local experiences across OECD countries, scaling them up will require both technical leadership and managerial support. It is time to realise the full potential of primary health care. REALISING THE POTENTIAL OF PRIMARY HEALTH CARE © OECD 2020 5 Acknowledgements The preparation and writing of this report was co-ordinated by Caroline Berchet and Frederico Guanais. Chapter 1 was written by Caroline Berchet and Frederico Guanais, Chapter 2 by Caroline Berchet, Cristian Herrera and Frederico Guanais, Chapter 3 by Caroline Berchet, Dionne Kringos (Academic Medical Centre, University of Amsterdam), Errica Barbazza (Academic Medical Centre, University of Amsterdam) and Frederico Guanais. Kees van Gool (University of Technology Sydney), Chunzhou Mu (University of Technology Sydney) and Jane Hall (University of Technology Sydney) carried out the statistical work underpinning the analysis of Chapter 3. Chapter 4 was written by Caroline Berchet and Frederico Guanais. Dionne Kringos (Academic Medical Centre, University of Amsterdam) and Erica Barbazza (Academic Medical Centre, University of Amsterdam) provided inputs to the policy analysis presented in Chapter 4. The preparation of Chapter 5 was a joint effort of a team of authors from the Bill & Melinda Gates Foundation (Hong Wang, Brienna Naughton, Ethan Wong, Nicholas Leydon, Caitlin Mazzilli, Susna De and Jean Kagubare) and the Ariadne Labs (Dan Schwarz, Amy VanderZanden and Asaf Bitton). This report also benefited from the material received from Alexandre Barna and Hélène Colombani (the Fédération Nationale des Centres de Santé), Luc Besançon (pharmaSuisse), Erkkila Eila (Deputy Chief physician – City of Oulu), Mary McCarthy (European Union of General Practitioners) and Lukas Sekelsky (Ministry of Health of the Slovak Republic). The authors are also grateful to the Netherlands Institute for Health Services Research which provided access to the Quality and Costs of Primary Care (QUALICOPC) data, and in particular to Peter Spreeuwenberg for its research assistance. Neither they nor their institutions are responsible for any of the opinions expressed in this report. At the OECD, Ian Forde, Michael Van den Berg and Niek Klazinga helped shape the overall direction of the report in an early phase. Nick Tomlinson, Francesca Colombo, Mark Pearson and Stefano Scarpetta provided valuable comments and suggestions at various stages of the project. Lukasz Lech, Duniya Dedeyn, Lauren Thwaites, Liv Gudmundson and Lucy Hulett provided vital support in the publication process. Thanks also go to José Bijholt, Frédéric Daniel, and Gabriel Di Paolantonio for their statistical support. The report was edited by Gemma Nellies. The authors would also like to extend gratitude to all of the delegates of the OECD Health Committee for their responses to the policy questionnaire and for providing valuable comments on a summary document presented to the OECD Health Committee in June 2019 and to a draft version circulated in August 2019. REALISING THE POTENTIAL OF PRIMARY HEALTH CARE © OECD 2020 6 Table of contents Foreword 3 Acknowledgements 5 Acronyms and abbreviations 10 Executive summary 11 1 Key findings 14 1.1. Strengthening primary health care offers opportunities to make health systems more efficient, effective and equitable 15 1.2. Primary health care is currently failing to deliver its full potential in many OECD countries 19 1.3. To strengthen primary health care in the 21st century it will be necessary to do things differently 26 1.4.
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