The Primary Care Spend Model: a systems approach to measuring investment in primary care

Abstract

Increased investment in primary care is associated with lower healthcare costs and improved population health. The allocation of scarce resources should be driven by robust models that adequately describe primary care activities and spending within a health system, and allow comparisons within and across health systems. However, disparate definitions result in wide variations in estimates of spending on primary care. We propose a new model that allows for a dynamic assessment of primary care spending (PC Spend) within the context of a system’s total healthcare budget. The model articulates varied definitions of primary care through a tiered structure which includes overall spending on primary care services, spending on services delivered by primary care professionals and spending delivered by providers that can be characterised by the ‘4Cs’ (first contact, continuous, comprehensive and coordinated care). This unifying framework allows a more refined description of services to be included in any estimate of primary care spend and also supports measurement of primary care spending across nations of varying economic development, accommodating data limitations and international health system differences. It provides a goal for best accounting while also offering guidance, comparability and assessments of how primary care expenditures are associated with outcomes. Such a framework facilitates comparison through the creation of standard definitions and terms, and it also has the potential to foster new areas of research that facilitate robust policy analysis at the national and international levels.

Primary Care Spending in the Veterans Health Administration in 2014 and 2018

“…Although direct comparison to other systems differs because of methods, our estimates suggest that primary care spending by the VHA may be higher than that by other US payers but lower than that by health systems outside the US (12%-17% in Organisation for Economic Co-operation and Development countries). 4 In addition, our estimates are below what many states have set as targets (>10% of spending on primary care) to improve outcomes and lower total costs of care. 5 Study limitations include that veterans may receive care outside the VHA.…”

The Role of Primary Care in Improving Population Health

“…In summary, the following policies will advance population health through primary care: Create and fund an NIH Institute for Generalism to support the generation of new knowledge on the health of whole people, communities, and populations. Actualize the recommendations of the NASEM report on Implementing High‐Quality Primary Care , 11 including a establishing and empowering a Department of Health and Human Services Secretary's Council on Primary Care and creating a scorecard to track progress in boosting state and national primary care infrastructure 205 Invest in primary care as a common good by doubling the current 6% of health care expenditure on primary care to 12% 11,154,206,207 and paying for primary care through capitation as the relationship‐centered frontlines for a more integrated, personalized health care system. Dramatically reduce administrative and documentation burden by revamping information systems to focus on clinically relevant rather than billing‐required information and focusing quality measurement on supporting the integrating, personalizing, and prioritizing functions of primary care, such as those assessed by the Person‐Centered Primary Care Measure 68 Invest in expanding the primary care workforce by redirecting graduate medical education and graduate nursing education support, including HRSA Title VII funding, toward primary care and community training settings 11,198 ; refocusing health care professional school admission processes so that trainees better reflect underserved populations 200 ; developing integrated training programs for members of the primary care team 11 ; and increasing HRSA Title VIII funding and loan forgiveness for those practicing in primary care, with additional incentives for those serving high‐need and underserved populations 201 …”

Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study

“…Others have previously investigated tiered models for PHC expenditure. 20 Our approach does not imply any successive ordering of interventions because many interventions are included under measure 2 and measure 3 that bring significant health benefits and are highly cost-effective.…”