Available at: Pan American Health Organization . [Accessed on 13 November 2021]; OECD. Greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality. Because of their unique clinical or content expertise, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. The https:// ensures that you are connecting to the Available at: Pan American Health Organization. No modifications or commercial use of this article are permitted. For any queries, please contact: [emailprotected], "Global Health Expenditure Report: Rising to the Pandemic's Challenges". A standard procedure is to consider it as the percentage of current health spending that corresponds to PHC spending (sum of PHC components, excluding administration). The MEDLINE search strategy is shown in Table 1. , Renewing primary health care in the Americas: a position paper of the Pan American Health Organization/World Health Organization (PAHO/WHO) Available at: Pan American Health Organization. , What are approaches that health economists, health services researchers, payers, health systems, and policymakers can employ to develop and implement a standardized measure of primary care spending and to assess spending over time, across payers/populations, and across states? This notice should be preserved along with the articles original URL. They should also produce cross tables of functions by provider and financing arrangements by function. 75Q80120D00006 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. CD53/5, Rec.2 Strategy for universal access to health and universal health coverage. What are the research gaps in understanding primary care spending estimation methods based on the findings of the evidence map? 6 New York: Oxford University Press; 1992. Dominican Republic, They may include clinical experts, researchers, payers, or other perspectives. Invited Peer Reviewers may not have any financial conflict of interest greater than $5,000. In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale. OECD Publishing; Paris: 2017. Three countries in the Region were chosen (Costa Rica, Mexico, and the Dominican Republic) that had expenditure data by provider and by function for the year 2017, at a sufficient level of disaggregation. The database can help to answer questions, such as how much countries spend on health, how much of the health spending comes from government, households, and donors, and how much of the spending is channeled through compulsory and voluntary health financing arrangements. Expenditure information that is based on types of activities or standardized goods and services, (and ideally) according to the provider involved, is much more informative than the content compiled in budget items that do not sufficiently detail the allocation of resources for PHC/FLC, which is very common in Latin American and Caribbean countries. Defining PHC means setting well defined boundaries. Estimates are based on data submitted using the System of Health Accounts 2011 framework. The broad WHO definition of PHC as first contact facilitates inclusion of services that reflect the way countries provide care to their populations. PHC/FLC expenditure was compared as part of Compact 30-30-30 monitoring, using WHO and OECD definitions for comparison. Van Mosseveld C, van Son P. Voorburg/ Heerlen. The Sustainable Development Goals (SDGs) aim to achieve universal coverage of essential and quality health services. Restricting data to OECD-defined outpatient providers has a substantial impact, reducing primary health care spending to 15.1% in Mexico, and 5.7% in both Costa Rica and the Dominican Republic (Table 2). Note: OECD definitions of PHC consider only outpatient providers. Technical Note: December 2021. 4 Latest OECD estimates point to average health expenditure growth of 5% in 2020, driven by the exceptionally high growth in spending by government and compulsory schemes (+8.1%) in response to the additional needs to address the COVID-19 pandemic. In order to ensure we capture relevant information on definitions and methodologies for measuring primary care spending, we will conduct gray literature searches with the assistance of a reference librarian. The SHA has proven to be a robust tool for the study of resource allocation to the goods and services covered by PHC. In this year's GHED update, we published health spending in 2020, the first year of the COVID-19 pandemic. German dialects can be tricky, even for professional interpreters. These searchers will focus on identifying reports generated by U.S. States and Federal Agencies, as well as health systems, and topic focused foundations. STAT Health. Thus, in the three countries analyzed, PHC expenditure according to the WHO parameter would exceed the 30% target in the 30-30-30 strategy. Inclusion in an NLM database does not imply endorsement of, or agreement with, United Nations. Federal government websites often end in .gov or .mil. Rathe M, Hernndez P, Van Mosseveld C, Pescetto C, Van deMaele N. Cuentas de salud del pasado al presente para una aritmtica poltica. The five questions below guide our work in synthesizing a description of research, ongoing efforts, and directions in measuring primary care spending. While these articles will not be analyzed in the same manner as publications that meet the inclusion criteria, specific international studies may be provided for purposes of contrast or discussion. Alongside the data, we are also pleased to announce the update of individual country profiles and primary health care country profiles for countries with available data. What are considerations for developing valid and standardized estimation of primary care spending? The feedback from the Key Informants will inform the approach our project team uses to organize the different definitions of primary care, the various ways of measuring primary care spending, the methodologies used, and the key characteristics of those methods (e.g., purpose and audience, definition of primary care, administrative burden, etc.). Please select the WEB or READ option instead (if available). Information gained from Key Informant interviews is identified as such in the report. However, we will ask Key Informants for their input on this, and look back in the literature further than 10 years if the experts recommend doing so. Global Health Expenditure Database, GHED. Rev Panam Salud Publica. The Brief will also add assessment to this information by including: 1) the advantages and disadvantages of the different approaches to estimating primary care spending, including how primary healthcare spending, which is the focus of international estimates, differs from primary care spending, which is the focus in the United States and therefore this Technical Brief; 2) an overview (map) of the evidence linking different primary care spending estimates to outcomes; 3) gaps that future research needs to address; and 4) key considerations for developing primary care spending estimates that are valid and may be standardized. The 2020 data also include COVID-19 specific health spending for a set of countries. Supplementary Evidence and Data: AHRQ will publish an announcement in the Federal Register to notify stakeholders about the opportunity to submit information via the SEADS portal on the Effective Health Care Website. The historical entry for Liesborn, Beckum, Mnster, Westfalen, Preussen, including parish and jurisdiction information, in the Meyers Gazetteer of the German Empire also known as Meyers Orts- und Verkehrs-Lexikon des Deutschen Reichs. OECD. Throughout the search process, we will identify and retain the subgroup of studies that look at primary care spending in the non-U.S.-based (international community). To better assess the differences, we performed a comparative analysis of the distribution of expenditure by function. Key Findings National health expenditures Change: 2009 to 2019 In 2019, current (nominal dollars) spending for national health expenditures was $3,795 billion. Available at: World Health Organization. (Eds.). Rathe M, Hernndez P, Van Mosseveld C, Pescetto C, Van deMaele N. Cuentas de salud del pasado al presente para una aritmtica poltica. Primary health care is a complex concept that stretches across different types of services and providers. Los gastos en APS como el porcentaje del gasto corriente en salud (GCS) en 2017 para OMS y OCDE, seran: Mxico (43,6% vs 15.1%); Repblica Dominicana (41,1 vs 5,75%) y Costa Rica (31,4% vs 5,7%).La definicin amplia de APS como primer contacto de OMS facilita la inclusin de servicios que reflejan la forma en que los pases ofrecen atencin a su poblacin. The expenditures of the three countries, by function, under the OECD and WHO definitions of PHC are presented as a percentage of current health expenditure (CHE), as a percentage of GDP, and per capita (Table 2). The .gov means its official. Health expenditure and financing. Even so, WHO could improve its category descriptions for international comparison purposes. Importantly, the rise in public health spending was part of a much broader fiscal response to the pandemic. [. HHS Vulnerability Disclosure, Help Measuring primary healthcare expenditure in low-income and lower middle-income countries. We propose to focus our searches on the last 10 years because any spending method prior to this are unlikely to be relevant today. Notes: 1. Primary health care expenditure in the Americas: measuring what matters*, An initiative to improve mental health practice in primary care in Caribbean countries, Clusters of rare disorders and congenital anomalies in South America, Mapping public health training in Latin America: perspectives for training institutions, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, Reregistration of the population residing in Foz do Iguau, Brazil, in compliance with the Primary Health Care Policy. Conversely, dental care spending is comparatively small in Poland, Belgium, Spain, the Netherlands and Romania, where it represents only around 3% of total health spending. Source: Prepared by the authors based on OECD and reference 13. The use of this work, whether digital or print, is governed by the Terms and Conditions to be found at http://www.oecd.org/termsandconditions. Acronyms: PHC: primary health care; WHO: World Health Organization; OECD: Organization for Economic Cooperation and Development; US$: US Dollar. If Key Informants cannot attend these open office hours we will email them to gain access to their advice and insights. Acronym: ICHA-HC: Classification of Health Care Functions; PHC: primary health care; WHO: World Health Organization; OECD: Organization for Economic Cooperation and Development. The capacity to measure primary care spending is essential to federal, state, and health systems efforts to promote the ability of primary care to improve healthcare delivery and outcomes. Pan American Journal of Public Health (PAJPH), Regional Office for the Americas of the World Health Organization. A System of Health Accounts 2011: Revised edition, OECD Publishing, Paris. They include services such as: 1) rehabilitation, which is not FLC in many countries, but can be part of a basic care package; 2) long-term care, which may fall under first contact and may be part of a basic care package and is important for controlling risk factors; 3) emergency transport, which is part of ancillary services and may constitute first contact and be included in basic care; the component associated with specialized and hospital-level services should be excluded; 4) over-the-counter medical goods (medicines, eyeglasses, hearing aids, and mobility aids), which can be considered first contact and relevant to quality of life and may be included as a product of a non-specialized outpatient visit (In countries where medicines are included in hospitalization, retail purchases correspond to follow-up medicines; in hospitals where medicines are not included or not available, retail sales could be higher, potentially leading to overestimation of primary care spending. PHC expenditures as a percentage of current healthcare spending in 2017 for WHO and OECD: Mexico (43.6% vs. 15.1%); Dominican Republic (41.1% vs. 5.75%), and Costa Rica (31.4% vs. 5.7%). Description of health services and goods/functions, Outpatient curative care not elsewhere classified (n.e.c.) [Accessed on 13 November 2021]. A shift in resources to support greater access to comprehensive, coordinated primary care is imperative to achieving a stronger, higher-performing healthcare system. Primary health care, health expenditures, measurements, methods, and theories, Atencin primaria de salud, gastos en salud, mediciones, mtodos y teoras, Ateno primria sade, gastos em sade, medidas, mtodos e teorias. , In high income and upper-middle income countries social protection spending also increased sharply as governments attempted to protect populations from the economic impacts of COVID-19. Using this as a proxy, primary health care accounts for around 13% of health spending on average across EUcountries, ranging from less than 10% in the SlovakRepublic and Romania to more than 17% in Lithuania and Estonia (Figure5.11). Universal health coverage (UHC) 12 December 2022. UN; New York: 2018. OECD; Paris: 2019. Or consider purchasing the publication. Where basic care services are provided by ambulatory health care providers such as medical practitioners, dentists, ambulatory health care centres and home health care service providers, this can be considered as a proxy for primary health care. 1 How have policymakers and other decision makers used primary care spending measures. exp general practice/ or internal medicine/ or pediatrics/. We would like to thank Julien Dupuy, of WHO, for his help with the cross tables of the countries studied and Hernn Luque and Jonas Gonseth, PAHO advisors, who were kind enough to read and comment on the content of the article. SHA 2011 makes it possible to identify and compare these differences. . ); 2. WHO (unlike the OECD) allocates 80% of the purchase of medical goods from retailers to PHC, as well as the administration of the system. All health systems are clearly different, so achieving international comparability requires agreement on what to include in the measurement of PHC. All authors reviewed and approved the final version. Is there any emerging consensus among experts in the field toward a standard or preferred method for assessment of primary care spending? Epidemiological surveillance and disease control programs are excluded, as well as prevention and preparedness for disasters and emergencies, because they are not part of first contact and basic care and are not offered in the selected outpatient care units. However, the inclusion of 80% of administrative and medical expenditure has been debated in many countries where there is more specialized care that reduces the proportion of this expenditure on PHC. The purpose of this Technical Brief is to organize the data and experience available from published peer-reviewed articles, gray literature, and experts on approaches used to estimate primary care spending in the United States. A metodologia SHA 2011 possibilita identificar e comparar essas diferenas. Countries will adopt specific solutions related to their problems. ICHA-HC: Classification of Health Care Functions; CHE: current health expenditure; n.e.c. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. However, in many EU and OECD countries, primary care has not yet fully realised this potential (OECD, 2020). Together with the data publication, we also released the annual report "Global Health Expenditure Report: Rising to the Pandemic's Challenges". Multidisciplinary FLC functions as a gateway (first contact) to the system to ensure equitable access to a comprehensive and integrated set of services that respond to the needs of the population. It also includes 80% of expenditure on medical goods (medicines, glasses, hearing aids, and prostheses) and 80% of expenditure on health system administration and financing, which reflects the effort to offer and organize primary health care. Mueller, M.and D.Morgan (2018), Deriving preliminary estimates of primary care spending under the SHA2011 framework; http://www.oecd.org/health/health-systems/Preliminary-Estimates-of-Primary-Care-Spending-under-SHA-2011-Framework.pdf. We will present our findings in the Technical Brief as responses to the Guiding Questions. This document, as well as any data and map included herein, are without prejudice tothe status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. A basic principle is to define health spending based on the goods and services provided or the functions covered. Available at: World Health Organization. The first will focus on helping us refine our search strategy, particularly by helping identify sources of gray literature. The decision to limit the scope of PHC to services delivered by OECD outpatient providers greatly restricts measurement, because it leaves out interventions that are intrinsic to the concept of PHC, such as collective preventive services. This project was funded under Contract No. Geneva Nevertheless, the cross-country comparability of this measure remains limited due to the diversity of organisational models for primary health care across EUcountries. A further challenge is sustaining external support for low income countries, which is essential for reducing poverty, ensuring access to health services and strengthening pandemic preparedness. 5 OECD iLibrary It should also be noted that the Task Order Officer has approved Dr. Phillips after disclosures. Os gastos em APS como percentual do gasto corrente em sade (GCS) em 2017, de acordo com os mtodos propostos pela OMS e pela OCDE, foram: 43,6% vs. 15,1% no Mxico; 41,1 vs. 5,75% na Repblica Dominicana; e 31,4% vs. 5,7% na Costa Rica. We will update the searches while the report is undergoing peer and public review to capture any recently added publications. OECD (2020), Realising the Potential of Primary Health Care, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/a92adee4-en. As a transitional step, we recommend that countries should monitor PHC funding and should explain what they include in their definition. 7.3, 8489. This compact proposes to eliminate at least 30% of access barriers by 2030 and to increase public spending to at least 6% of GDP, with at least 30% of these resources being directed to the first level of care. In 2017, a convening to develop a framework for measuring primary care spending was held that brought together health economists, health services researchers, and policymakers from the United States and abroad. OECD . P 27. Numa etapa de transio, recomenda-se aos pases monitorar o financiamento da APS, explicitando os itens includos na definio empregada. All data abstractions will be reviewed for completeness and accuracy by another member of the team. It includes spending on basic health services, based on the SHA 2011 classification of health functions, when care is provided in outpatient units. Prevention services (9%) as well as home visits by GPs or nurses (2%) make up a much smaller proportion of spending on primary care. A further 39% is related to dental care. STAT. In order to inform policies, it is important to specify how the system is organized and the policies that support the provision of basic and first-level services in each country. This requires reaching consensus on the definition of PHC, key expenditure indicators, and how to measure them. Key Informant expertise on the topic will be used to inform our search strategy, supplement what we find in the published literature and gray literature, and provide suggestions on how to organize our findings to answer the Guiding Questions. This is not possible in other places, e.g., the Netherlands, where a referral from a general practitioner is mandatory under basic insurance (17). No entanto, as categorias deveriam ser mais bem detalhadas para facilitar a comparao internacional. The AHRQ Task Order Officer reviewed contract deliverables for adherence to contract requirements and quality. CD53/5, Rec.2 Strategy for universal Access to health and universal health coverage. For poor countries, PHC represented a way of overcoming the resource limitations which stand in the way of a transformation of the health situation. In case of discrepancy, the original version shall prevail. Available at: OECD, Eurostat and World Health Organization . Internet Citation: Chapter 16. 2 We will include systematic reviews, other types of reviews, and primary studies of primary care spending estimates in the United States. government site. Rio de Janeiro routine visits to a GP or nurse for acute or chronic treatment), Dental outpatient curative care (e.g. Primary E-mail: * Yes, I Want It! (("provider based" or "service based" or "system based") adj3 (care or healthcare)).ti,ab. As we are based in Essen, Germany we will take a look at the different German dialects. Strengthening primary care has been identified as an effective policy tool to improve care coordination and health outcomes and reduce wasteful spending, by limiting unnecessary hospitalisations and associated costs in hospitals and other parts of the health system. Although financial conflicts of interest that cumulatively total greater than $1,000 will usually disqualify EPC core team investigators, the lead Investigator and EPC leadership for this Technical Brief have reviewed his disclosures and have concluded they are manageable and not unexpected due to the limited expertise in the field of study. The classifications are the product of an international consultation (8) aimed at establishing relevant categories consistent with international spending classifications according to the purpose of each expenditure (by the public sector (9) and the private sector (10)), adjusted to the information needs of the health system. As there is no consensus on definitions or methodology for measuring primary care spending and published literature of the definitions, approaches to estimation, and usage of different estimates is expected to be limited this Technical Brief will integrate information from discussions with Key Informants and findings from the gray literature, with published literature. OECD. and transmitted securely. 2019. Thought leaders and researchers in this field have started to identify the range of primary care and primary care spending conceptualizations,1-3 and begun the work of documenting pros and cons of different approaches,4,5 but these efforts have not been comprehensive. We will ask that they recommend sources covering the scope of the Technical Brief including: known states or organizations with approaches to measuring primary care spending; databases (public and proprietary) used to estimate primary care spending, and the attributes of those databases that might influence estimates; identification of core clinicians, healthcare professionals, and services that should be included in the definition of primary care; the pros and cons of different definitions; recommendations for moving toward consensus on or harmonization of definitions of primary care and primary care spending, as well as other related issues that may arise during the discovery process. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, https://effectivehealthcare.ahrq.gov/products/primary-healthcare-spending/protocol, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, State Primary Care Investment Initiatives, Strategies for Integrating Behavioral Health and Primary Care, Integrating Palliative Care in Ambulatory Care of Non-Cancer Serious Chronic Illness, Strategies for Patient, Family and Caregiver Engagement, U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, National Academies of Sciences, Engineering, and Medicine, Organization for Economic Co-operation and Development. It is important that international organizations agree on better content, rethinking prevention and administration, as well as medical goods. Oswaldo Cruz Foundation (FIOCRUZ), 2022 November 30; 46: e210, https://www.paho.org/en/file/57500/download?token=6kn334ab, https://www.paho.org/en/file/57500/download?token=6kn33 4ab, https://iris.paho.org/bitstream/handle/10665.2/28276/CD53-5-e.pdf?sequence=1&isAllowed=y, https://iris.paho.org/bitstream/handle/10665.2/28276/CD53-5-e.pdf?sequence=1&is Allowed=y, https://www.paho.org/hq/dmdocuments/2010/Renewing_Primary_Health_Care_Americas-PAHO.pdf, https://www.paho.org/hq/dmdocuments/2010/Renewing_Pri mary_Health_Care_Americas-PAHO.pdf, https://digitallibrary.un.org/record/409196?ln=en, https://unstats.un.org/unsd/classifications/unsdclassifications/COICOP_2018_-_pre-edited_white_cover_version_-_2018-12-26.pdf, https://www.oecd.org/health/health-systems/Preliminary-Estimates-of-Primary-Care-Spending-under-SHA-2011-Framework.pdf, https://www.oecd.org/health/health-systems/Preliminary-Estimates-of-Prima ry - Care-Spending-under-SHA-2011-Framework.pdf, https://apps.who.int/nha/database/DocumentationCentre/Index/en. Most EPC core team members have no financial conflicts of interest greater than $1,000 and any other relevant business or professional conflicts of interest. In short, the definitions established by the OECD and WHO differ in terms of how PHC is conceptualized: (a) the starting point of operationalization as basic care versus care at first contact, (b) the breadth of services included (i.e., defining what to measure); and (c) the inclusion or non-inclusion of the providers involved, or how to measure this. Health expenditure data are reported annually to the OECD by the 38 member states and are available in its database. Primary care: concept, evaluation, and policy. Accessibility This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. is the online library of the Organisation for Economic Cooperation and Development (OECD) featuring its books, papers, podcasts and statistics and is the knowledge base of OECD's analysis and data. Chotchoungchatchai S, Marshall AI, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Tangcharoensathien V. Primary health care and sustainable development goals. SHA 2011 makes it possible to identify and compare these differences. Measuring Primary Health Care Expenditure under SHA 2011. The EU average is unweighted. Primary care: concept, evaluation, and policy. >> . The components of each package of services can be classified as first contact or basic care, according to national criteria. Defining expenditure on basic services without taking into account specific providers would seem to be the most appropriate when tracking PHC spending and for international and time comparison purposes. [internet] PAHO, Washington, D.C. Pan American Health Organization. They do not systematically include PHC spending (14). For example, it is difficult to separate general and specialized services. We will also search any identified clearinghouse or databases with relevant gray literature such as the National Library of Medicine digital collection, Health Policy and Services Research.
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