Sufficient and Efficient Spending on Primary Care Benefits National Health and Health Systems

Author(s)

Phillips, Robert L, Fisher, Rebecca, Jackson, Claire, Martin, Danielle, Olde Hartman, Tim, and Goodyear-Smith, Felicity

Topic(s)

Role of Primary Care, What Family Physicians Do, and Achieving Health System Goals

Keyword(s)

Physician Experience (Burnout / Satisfaction), Quality Of Care, and Teams

Volume

The Milbank Quarterly

Policy Points Primary care is undervalued and under-funded in many countries despite different care and payment models. High-quality, accessible primary care requires sustained and strategic investment. Team-based care, sustainable and engaged workforce models, and technology that enhances rather than fragments care are priorities that are shared across nations. Countries can adopt a principled approach by paying for primary care teams to care for people not physicians to deliver services; ensure that high-quality primary care is available to every individual and family in every community, and ensure that high-quality primary care is implemented with measurement and accountability. Context Primary care is the foundation of most health systems; yet across diverse countries, structures, policies, and payment models, it is under threat. Many high-income countries face shrinking workforces, worsening access, disrupted continuity, and reduced comprehensiveness. Methods Common drivers include underfunding and spending that is inefficient, leading to workforce crises and rising clinical and administrative burdens that drive burnout. Findings These shared challenges require shared solutions. Strengthening primary care means adequate funding that is wisely invested to increase workforce capacity—including general practitioners and other primary care team members such as nurses, pharmacists, and social workers—and promotion of sustainable models of care. Policies that impose unfunded mandates or devalue core functions such as continuity and comprehensiveness erode system performance and make it impossible for primary care to deliver on its promise for cost, utilization, satisfaction, and health outcomes. Conclusions Sufficient and efficient funding in team-based, person-centered primary care must be a political and policy priority.

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