Effective primary healthcare is the cornerstone of an efficient, people‑centred, and equitable health system. While the COVID‑19 pandemic has highlighted the importance of resilient primary healthcare systems, in many EU countries, the potential of primary healthcare has not yet been fully realised (OECD, 2020[5]).
In 2022, EU countries allocated an average of 13% of their health budgets to primary healthcare, with this proportion ranging between less than 10% in Luxembourg and the Netherlands and close to 20% in Estonia and Lithuania (Figure 5.9). On average, the share of primary healthcare in overall health spending in 2022 was similar to the one observed in the pre‑pandemic period. With the onset of the COVID‑19 health emergency, there was an initial drop in the share of spending on primary healthcare partly due to the postponement of service use, in particular for dental care. In 2021, a “catch-up” effect was observed, with the share of overall health spending dedicated to primary healthcare increasing in most EU countries.
General outpatient care (e.g. GP visits) is the most important component of primary healthcare spending, accounting for nearly half of all primary healthcare costs in the EU. There is a significant variation in this component across countries, with the share of general outpatient care in total health expenditure exceeding 10% in Poland and Slovenia while being 4% or lower in France, Germany and Luxembourg. Dental care accounts for over one‑third of primary healthcare spending on average across the EU and displays a similar variation. Top spenders include Estonia and Lithuania where spending on dental care represents 10% of the overall health budget. This share is significantly smaller in the Netherlands and Spain (3%). The remaining components of primary healthcare are prevention (if provided by ambulatory care providers) and home‑based curative care, which both only make up a small proportion, representing on average 11% and 5% of all primary healthcare spending, respectively.
The COVID‑19 pandemic has had a substantial impact on total preventive spending – referring to preventive services by ambulatory care providers and other providers. While, on average, spending on prevention stood at slightly less than 3% of overall health spending in the EU between 2015 and 2019, the mobilisation of additional funding for COVID‑19 public health measures led to a two‑step increase of this indicator in 2020 (to 3.3%) and 2021 (to 5.5%). This was the result of the substantial financial resources going into testing programmes to detect the virus, pandemic surveillance, emergency co‑ordination, and vaccination campaigns. With the phasing out of many of the pandemic emergency measures in 2022, the share of overall health expenditure allocated to prevention dropped again (to 4.3%) but remained above pre‑crisis levels (Figure 5.10). In 2022, the highest spenders on prevention were Germany and Austria who dedicated between 7‑8% of their total health budget to it. On the other hand, in 2022, preventive spending represented only a relatively small share of the health budget in Poland and the Slovak Republic.
To what extent some of the recent investments in prevention and public health interventions go beyond time‑limited emergency measures and have a more lasting impact on population health is unknown at this stage. That being said, one important lesson of the COVlD‑19 pandemic was that EU health systems were not able to cope with a health emergency of this magnitude. OECD analysis suggests that targeted additional spending on preventive care is needed as one component of a strategy to strengthen countries’ health system resilience and their agility to respond to pandemics and other evolving threats (OECD, 2023[6]).
