Primary care is often people’s first point of contact with health systems. Inadequate access to high quality primary care for conditions such as asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes, can lead to hospital admissions that could have been avoided. Common to all four conditions is that the evidence base for effective treatment is well established, and much of it can be delivered by primary care. A high-performing primary care system, where accessible and high-quality services are provided, can reduce acute deterioration in people living with asthma, COPD, CHF and diabetes. For example, for diabetes, effective control of blood glucose levels through routine monitoring, dietary modification and regular exercise, and appropriate use of pharmaceuticals can reduce the onset of serious complications and the need for hospitalisation. Management of key risk factors such as smoking, blood pressure and lipid levels is also important in reducing complications. Hospital admissions for these conditions can be used as a marker of quality and access to primary care, with the proviso that very low admissions rates may also partly reflect reduced access to acute care.
Figure 6.9 shows that the combined hospital admission rates for asthma and COPD fell by 35% between 2013 and 2023 – now averaging 155 admissions per 100 000 population across OECD countries. Hospital admission rates ranged from fewer than 20 admissions per 100 000 in Costa Rica to over 250 admissions per 100 000 in Ireland, Australia, Denmark, the United Kingdom and Germany. As noted above, a component behind very low admissions relates to access, as Costa Rica has the lowest number of hospital beds per capita among OECD countries (see section on “Hospital beds” in Chapter 5).
Advances in cardiovascular disease (CVD) care and management, and progress in reducing CVD mortality, have led to increasing numbers of people living with chronic cardiovascular conditions, including CHF. Hospital admission rates for CHF varied 12‑fold across OECD countries (Figure 6.10). As with asthma and COPD, Costa Rica had the lowest rate, while Poland and Lithuania reported a rate over twice the OECD average. The average admission rate across OECD countries fell by 16% between 2013 and 2023 – and it fell by over 30% in Austria, Belgium, Estonia, Italy and Portugal. Admissions for CHF increased in several countries over this period, including Iceland, Norway, the Slovak Republic, Switzerland and the United States. Patients can be supported in self-management activities to control clinical and behavioural risk factors and to manage their conditions (see section on “Effective care for chronic conditions”) (OECD, 2025[1]).
Figure 6.11 shows that in 2023 there was a more than seven‑fold variation in hospital admissions for diabetes across OECD countries. Italy, Iceland and the Netherlands reported the lowest rates, while the United States reported rates more than twice the OECD average, as did OECD accession country Romania. Although admissions for diabetes fell on average between 2013 and 2023 (from 151 to 111 per 100 000), a number of countries observed increases. Admissions for diabetes increased by more than 10% over this period in Israel, Latvia, Spain, Switzerland, the United Kingdom and the United States. Prevalence of diabetes and general access to hospital care may explain some of this variation. As with heart failure, ongoing control of diabetes usually involves a considerable amount of self-management; therefore, patient-centred care instruction and education are central to primary care of people with diabetes (OECD, 2020[2]).
