Even before the COVID‑19 pandemic, health systems in OECD countries faced significant challenges. Citizen expectations about health services are high, societies are ageing, health spending is rising in response to more complex health needs, and fiscal pressures make it difficult to expand allocations of resources to the health sector. The rapid spread of COVID‑19 added complexity to these challenges, given both the surge in demand for treatment of the acutely ill and the need to continue to deliver preventive care and manage chronic patients. In this context, primary health care plays a key role for health systems to deliver more and better services. As the first point of contact that is expected to address the majority of health needs, strong primary health care has all the potential to improve health outcomes for people across socio-economic levels and to reduce unnecessary use of more expensive specialised services. But is primary health care across the OECD ready and living up to these expectations?

Primary health care can save lives and money while levelling the playing field to achieve more equal access to medical treatment. Such positive outcomes materialise when primary health care is a primary source of care that addresses the majority of their patients’ needs, knows their medical history, and helps them to co-ordinate care with other health services as needed. While in most OECD countries primary health care has not yet realised this full potential, several initiatives already show the way forward.

This chapter provides an overview of the publication Realising the Potential of Primary Health Care, as well as summarising the main findings. The chapter starts by presenting the evidence base that associates strong primary health care with more efficient, effective and equitable health care systems. The second section shows that primary health care is currently failing to deliver its full potential in many OECD countries, hampered by avoidable hospital admissions, inappropriate antibiotic prescriptions, insufficient preventive care or shortcomings in co‑ordination. The third section identifies policy levers to tackle these challenges, and provides an overview of the report’s findings on how primary health care could provide more efficient, effective and equitable care. The concluding section presents a summary table of the key policy ingredients that countries will need to address to realise the full potential of primary health care.

This chapter analyses the efficiency of primary health care across OECD countries. The chapter starts with a review of published studies which shows that strong primary health care makes health systems more efficient, notably by containing the rate of growth in health spending, and by reducing the use of costly hospital inputs. The chapter then goes on to show that there are unrealised opportunities from better primary health care, and that systems will need to operate differently in order to reap better efficiency from primary health care across OECD countries. The chapter concludes by identifying areas where policy makers need to act so as to realise efficiency gains. Special emphasis is devoted to changes in training and improved matching of skills to tasks, greater use of digital technology, financial incentives that encourage good primary health care processes and good health outcomes, as well as availing primary and community care options.

This chapter turns to the question of whether primary health care is delivering effective and responsive care. The chapter shows that as the first point of contact with the health care system, primary health care teams are in a unique position to advise patients on health behaviour, to administer preventive care, and to control the progress of chronic conditions. This is ever more needed as citizen expectations about services are high, societies are ageing and complex cases are costly. The chapter then shows that strong evidence suggests preventive care is inefficient across OECD countries and there are break-downs in communication between primary health care and other sectors of the health care system. The chapter concludes by describing the policy levers needed to encourage both the effectiveness and responsiveness of primary health care. These range from new models of organising services based on a team or network of providers, changes to the incentives that determine clinical practice, better measurements of quality and outcomes of primary health care, to implementing health coaching and counselling.

This chapter builds on available evidence to present a comprehensive set of policy actions to reduce social health inequalities and promote more inclusive societies by leveraging primary health care. The first section of the chapter presents the evidence base associating strong primary health care and lower social health inequalities. This is followed by an assessment of the many financial, structural, and personal barriers impeding access to primary health care across OECD countries, which can result in or exacerbate social health inequalities. Section   presents several policy actions on both demand and supply sides to tackle social health inequalities. Special emphasis is devoted to organisation changes in primary health care necessary to bring care closer to people and communities that are typically underserved, and to enable patients to make the best of their health by addressing social and economic barriers to care.

Primary health care has been identified as a crucial health system component, and universal health coverage is now a top priority for the countries. This chapter highlights the major contributors to and components of the primary health care landscape in low- and middle-income countries, and the key strategic approaches to address these fundamental challenges with the aim of ensuring the continued development towards high-quality primary health care systems. The enabling factors of governance in primary health care systems frame the discussion, while a deep dive into primary health care measurement highlights its importance in improving systems. The chapter then discusses how the strengthening of service delivery quality requires considerations of safety, knowledge, and patient perspectives, and how effective financing of primary health care includes the leveraging of the current understanding of primary health care expenditures and the financial tools available. Finally, the chapter shows how with the incorporation of cross-country learning, engagement with the private sector, and leveraging of innovations, primary health care systems can continue to strengthen and advance towards universal health coverage.