How to measure the strengthening of primary care?

Problem

The 2018 Astana Global Primary Health Care Conference Declaration suggests that “strengthening primary health care is the most inclusive, effective, and efficient approach to enhance physical and mental health.” Recent reforms in the UK and internationally have agreed on the importance of strengthening of primary care, but there is less agreement in how to show evidence of strengthening. The aim of this research is to evaluate if this can be observed using resource allocation methods.

Approach

We estimate spending on primary care as a proportion of health spending using Australian national statistics. We compare methods to estimate primary care spending developed by OECD and WHO, with a newer methodology for estimating primary care spending - "PC Spend". Using PC Spend methodology we categorise health spending into 3 categories. Level A is the broadest category and includes all ambulatory care, and dental spending. Level B includes direct spending on primary care services, such as delivery of general practice services. Level C is restricted to high value primary care spending such as patient centred medical home (PCMH) payments or funding to improve care coordination. We use Australian Bureau of statistics data, and will provide comparisons between Australia, USA and UK.

Findings

Using OECD methodology (but excluding pharmaceuticals), over 18% of health spending is categorised as being on primary health care services. Using PC Spend methodology we find results for PC Spend A, B and C at 19.6%, 6.8% and <1% respectively. The multiple levels of the PC Spend methodology provides a more granular assessment of how much of health budget is being spent on first contact, comprehensive, coordinated health services than OECD/WHO measures. This has the potential to better reflect the impact of health system reforms on primary care. Further work is needed for each country’s health system to determine what components of high value primary care spending warrant inclusion in PC Spend Level C.

Consequences

These results confirm that despite calls for strengthening of primary care, spending on direct delivery of primary care services remains under 10% of health spending in Australia. Changes in primary care spending have potential use as a proxy for strengthening of primary care, and these methods require further testing and refinement.