Effective primary healthcare is the cornerstone of an efficient, people‑centred, and equitable health system. Strengthening primary care has been identified as an effective way to improve care co‑ordination and health outcomes and reduce wasteful spending, by limiting unnecessary hospitalisations and associated costs in hospitals and other parts of the health system. Moreover, the COVID‑19 pandemic has shown that for health systems to be resilient in the face of health crises, strong primary and community healthcare is essential. However, in many OECD countries, primary care has not yet fully realised this potential (OECD, 2021[1]).
In 2021, primary healthcare accounted for 13% of health spending on average across OECD countries, ranging from 10% or less in Austria, Luxembourg, the Netherlands and Switzerland to nearly 20% in Slovenia and Estonia (Figure 7.17). Compared to 2019, this proportion has remained unchanged suggesting that primary care spending increased in line with overall health spending during the COVID‑19 pandemic.
Regarding its composition, half of primary care spending across OECD countries is on general outpatient care services, with a further third related to dental care. Prevention services as well as home visits by GPs or nurses make up a smaller proportion of spending on primary care, although often services related to prevention activities may be hard to distinguish from general outpatient consultations. General outpatient care provided by ambulatory providers was particularly high in Costa Rica, Poland and Mexico, reaching up to 13% of overall health spending. In Austria, Germany, France, Luxembourg and Switzerland, spending on general outpatient care is much lower overall, accounting for 4% or less of health spending.
In Lithuania and Estonia, the large share of primary care in overall health spending can be explained by spending on dental care. In both countries, dental care accounts for over 8% of their total health budget – nearly twice the OECD average. This compares with Mexico, the United Kingdom, Costa Rica and the Netherlands, where dental care spending represents only around 3% of total health spending.
Total spending on prevention (referring to services provided by ambulatory care providers and others) increased significantly across OECD countries with the onset of the COVID‑19 crisis (see indicator “Health expenditure by type of service”). As a share of total health expenditure, spending on prevention doubled since 2019 on average across OECD countries (Figure 7.18), reaching more than 5% in 2021. Spending on prevention increased by more than 6 percentage points in Austria, Denmark, the Netherlands and the United Kingdom, reflecting substantial investments in public health measures related to fighting the spread of the COVID‑19 pandemic.
An increase in spending on prevention might be welcomed, yet much of the spending growth in 2021 can be attributed to time‑limited, emergency measures related to COVID‑19 management – such as testing, surveillance, and vaccination campaigns – rather than long-term planned investments into population health. In the United Kingdom, for example, the growth in prevention spending was triggered by the GBP 15 billion allocated to the NHS Test and Trace Programme for COVID‑19. OECD analysis suggests additional spending on preventive care is needed to strengthen countries’ health system resilience and their agility to respond to pandemics and other evolving threats (OECD, 2023[2]).
