Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities.

Publisher: Blackwell Publishers Country of Publication: United States NLM ID: 8607003 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-0009 (Electronic) Linking ISSN: 0887378X NLM ISO Abbreviation: Milbank Q Subsets: MEDLINE

Publication: Malden, MA : New York, NY : Blackwell Publishers ; Milbank Memorial Fund
Original Publication: New York, NY : Published for the Milbank Memorial Fund by Cambridge University Press, c1986-

Health Policy/*trends ; Primary Health Care/*economics ; Research/*trends; Delivery of Health Care/economics ; Delivery of Health Care/methods ; Delivery of Health Care/trends ; Humans ; Primary Health Care/trends

Policy Points The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services.
Context: The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits.
Methods: We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance.
Findings: We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services.
Conclusions: There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.
(© 2021 The Authors. The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Millbank Memorial Fund.)

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001 International WHO_ World Health Organization

Keywords: Coverage; Economics; Financing; Governance; Primary Care Services; Service Delivery; Umbrella Review

Date Created: 20210902 Date Completed: 20220112 Latest Revision: 20240405

20240405

PMC8718591

10.1111/1468-0009.12536

34472653