With the share of the population aged 65 and above set to increase to 27% by 2050, OECD countries must adapt their health systems to deliver more effective and high-quality care for people living with chronic conditions, while avoiding unnecessary use of hospital and specialised services. By providing the main point of contact for patients and especially for those with complex care needs, strong primary healthcare is an effective way to improve care co-ordination and health outcomes and reduce wasteful spending, by limiting unnecessary hospitalisations and the associated costs in hospitals.
Primary healthcare
Primary healthcare can save lives and money while also promoting equal access to medical treatment. To achieve this, primary healthcare providers should be the primary source of care for patients, be able to address the majority of their needs, know their medical history, and help to co-ordinate care with other health services as needed.
Key messages
During the first phase of the COVID-19 pandemic, much focus was placed on scaling up hospital capacities. However, the pandemic has also deeply affected the health of many people who live with underlying health conditions. People living with chronic conditions are not only highly vulnerable to complications and to dying from COVID‑19, but they are also suffering from disruptions to their regular care routines.
Primary healthcare efforts that focus on prevention need to be reinforced in order to improve early detection and long-term management of chronic conditions, therefore enabling people to feel more in control of their health. By doing this, societies and health systems can be better prepared for future health shocks when they arise.
The COVID-19 pandemic has significantly impacted the health systems in Latin American countries. In Peru and Mexico, excess mortality was higher than in any other country in the world, two to three times higher than the OECD average. Seven Latin American countries lagged behind other OECD countries in terms of preventive care and faced challenges in maintaining routine care during the COVID-19 pandemic, revealing the limitation of primary healthcare to absorb the impact of the COVID-19 pandemic and recover from it. More effective prevention at primary healthcare level will increase the readiness and resilience of health systems to face future high-impact shocks.
Context
Avoidable hospitalisations
Primary healthcare has not always been successful at keeping people out of hospitals. Hospital admission rates for asthma and chronic obstructive pulmonary disease (COPD), which are largely avoidable through good access to high-quality primary care, varied 15-fold across OECD countries in 2021. Mexico, Italy and Chile reported the lowest rates at 3 times lower the OECD average, while Australia and Denmark reporting the highest, at over twice the OECD average.
Insufficient focus on prevention contributes to these results. As a share of total health expenditure, spending on prevention reached 5% in 2021, but most of this was related to time-bound emergency measures related to COVID-19 management – such as testing, surveillance, and vaccination campaigns – rather than long-term planned investments into population health.
The impact of COVID-19 on primary care
In addition to having a higher risk of severe COVID-19 symptoms, people living with certain chronic conditions were affected by care disruption. On average, 37% of those who indicated having a serious chronic health condition reported cancelled or postponed care, compared to only 26% of people without a chronic health condition.
There have also been other challenges in maintaining routine care. For example, in Latin America there have been large changes in vaccination coverage, with diptheria, tetanus and pertussis vaccines among one year-old children seeing an 8% drop in 2020 compared to the 2015-2019 average. Disruption of cancer screening and early detection services was also large.
Access to primary care doctors
Consultations with primary care doctors are for many people the most frequent contact with health services, and often provide an entry point for medical treatment. Having enough GPs or family doctors available is a crucial factor in ensuring people can access the care they need in a timely manner.However, they represented less than one-quarter (23%) of all physicians on average across OECD countries in 2021, ranging from around half in Portugal, Chile and Canada to just 6% in Korea and Greece.
The wide variation across countries can be partially attributed to differences in the ways doctors are categorised. For example, in the United States and Israel, general internal medicine doctors often play a role similar to that of GPs in other countries, yet they are categorised as specialists.
