Effective primary healthcare (PHC) is the cornerstone of an efficient, people‑centred, and equitable health system. Strengthening PHC 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. However, in many OECD countries, PHC has not yet fully realised this potential.
In 2023, PHC represented 14% of all health spending on average across OECD countries, ranging from 10% or less in Switzerland, the Netherlands, Luxembourg and the Slovak Republic to around 20% in Lithuania, Estonia and Finland (Figure 7.16). Compared to a decade ago, this share has remained largely unchanged, indicating that spending on PHC has been growing in line with overall health spending. Thus, this suggests that PHC has by and large not been the main focus of targeted investment in the health sector.
Regarding its composition, half of PHC spending across OECD countries is on general outpatient care services, with a little over a third related to dental care. Prevention services and home visits by general practitioners (GPs) and nurses make up a smaller proportion of spending on PHC, although services related to prevention activities may often be hard to distinguish from general outpatient consultations. Spending on general outpatient care provided by ambulatory providers was particularly high in Costa Rica, Poland and Mexico, reaching up to 14% of overall health spending. In Austria, Canada, Germany, France, Luxembourg and Switzerland, spending on general outpatient care was much lower overall, accounting for 4% or less of health spending.
In Lithuania and Estonia, the large share of PHC in overall health spending can be explained by spending on dental care. In both countries, dental care accounts for around 10% of their total health budget – twice the OECD average. This compares with the Netherlands, Costa Rica, Mexico, Poland and the United Kingdom where dental care spending represents only around 3% of total health spending.
Total spending on prevention (referring to services and public health interventions provided by ambulatory care providers and in other setting) has remained relatively stable at 3% of overall health spending across OECD countries in the decade leading to the pandemic – but increased significantly with the onset of the COVID‑19 crisis. By 2021, this share had climbed to 6% (Figure 7.17). This increase was particularly pronounced in Denmark, the United Kingdom, Austria and Japan, where the proportion of health spending attributed to preventive care was 7‑8 p.p. above the share seen in 2013, reflecting substantial investments in public health measures related to fighting the spread of the COVID‑19 pandemic. However, much of the pandemic-induced spending growth in 2021 was related to time‑limited, emergency COVID‑19 measures rather than long-term planned investments into population health. With public health emergency measures phased out after the acute phase of the pandemic, the share of preventive spending dropped and reached pre‑pandemic levels by 2023, ranging from 6‑7% of total health spending in Canada and the United Kingdom to less than 3% in Poland, Belgium, Iceland, France, Switzerland, Portugal and Japan. The fact that the position of prevention and public health in overall health budgets has not changed much after the experience of the COVID‑19 pandemic may suggest that health systems remain similarly vulnerable to a major health crisis. It also indicates that additional spending on preventive care is still needed to strengthen countries’ health system resilience and their agility to respond to pandemics and other evolving threats (OECD, 2023[1]).
