Defining and Measuring the Primary Care Spend

Problem

We need to draw policymakers’ attention to evidence that primary care improves outcomes at lower costs. However, there are no standard methods of measuring how much of a country’s healthcare expenditure is on primary care so it’s very hard to provide data on how a country is performing.

Approach

A multinational, multidisciplinary expert group was convened for a two day meeting at the Robert Graham Center in Washington DC. The aims of the meeting were to: 1. Share updates about ongoing efforts to measure primary care spending.2. Define differences between current definitions of primary care and how it is measured.3. Develop consensus about core primary care inclusion elements as components of a unified definition. 4. Identify needed exclusions to the unified definition and ways to support comparability.5. Develop an overarching method that can be used for future research and policy development.

Findings

In this presentation, we will report back on the key conclusions from the meeting which include:(1) There are two fundamental approaches for tracking primary care expenditure currently in general use, the provider approach (tracking expenditures from identified primary care providers) and services approach (tracking expenditures from identified primary healthcare or essential healthcare services). (2) In high income countries or in countries with well-developed healthcare systems, the provider approach is typical; in low income countries or those with poorly developed healthcare systems, the services approach is more typical.(3) These two predominant modes of expenditure accounting don’t fully capture the intention of supporting robust primary health care, and in order to achieve this goal a three-tiered measurement framework was proposed with the aspiration to eventually arrive at the third-tier, which includes service by provider in the context of the 4-Cs.a. Service is the first level (base level) tracking approach. This approach is to track expenditure based on a defined package of primary care, primary healthcare, essential healthcare, or basic healthcare services regardless where they are delivered. This approach is especially applicable for LMICs where the PHC system is weak, and PHC services could be delivered by several sites within the healthcare system. b. Service plus provider is the second level tracking approach. This approach measures expenditure based on both services and providers and is favoured for OECD countries. c. The third level approach measures expenditures on high performing primary care (real primary care) which accounts for services delivered by primary care providers in the context of First Contact, Comprehensiveness, Continuity and Care Coordination. This is a directional approach and subject to further system and measurement development.

Consequences

The conclusions of the meeting are an important first step in gaining internationally agreed approaches to measuring primary care spend.